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Aortic Dissection
THE JOURNAL OF MEDICINE FOR THE WORLDWIDE MED COMMUNITY
Расслоение аорты
Fig. 4: (a) Malperfusion of distal aorta
by occlusive type B dissection.
(b) Stent-graft placement in the true
lumen of the proximal descending
aorta reestablished flow to the abdomen
and legs.
Рис. 4: (a) Мальперфузия дистальной
аорты, вызванная окклюзивной
диссекцией В-типа. (b) Стент-графт
размещен на проксимальном участке
истинного просвета нисходящей
аорты, тем самым восстановлено
кровоснабжение внутренних органов и
нижних конечностей.
lumen in 20%-50% patients
at 4 years [1,26]. Expansion of
the false lumen over 4 cm in
diameter and persistent perfusion
of the false lumen are
considered predictors of aortic
rupture and death [20,21].
There is consensus that TEVAR
should be considered when
aortic diameter exceeds 55-60
mm, increase of recurrent
thoracic pain, or in presence
of uncontrolled blood pressure
and rapid growth of the dissecting
aneurysm (>1 cm/year)
[Fig. 5]. Nienaber et al prospectively
evaluated stent-graft
management in 12 patients
with chronic type B dissection
and compared the results with
12 matched surgical controls
[22]. Proximal entry closure
and complete thrombosis of
the false lumen at 3 months
were achieved in all patients.
Stent-graft treatment resulted
in no morbidity or mortality,
whereas surgical treatment
resulted in 4 deaths (33%;
p=0.04) and 5 adverse events
(42%; p=0.04) [22]. Similar
results were obtained by Kato
in a series of 15 patients with
no mortality during a follow-up
of 2 years [23]. Eggebrecht el
al compared the clinical outcome
of 38 patients with type
B aortic dissection (10 acute
and 28 chronic) after TEVAR a
lower in-hospital mortality and
a trend towards better 4-year
survival rate in patients with
a
chronic aortic dissection [24].
However, prophylactic implantation
of stent-graft in patients
with chronic type B aortic
dissections was not superior
to efficient medical treatment
with 2 years of follow-up in the
INSTEAD trial [20].
Traumatic Aortic Dissection
Blunt aortic injury is not
infrequent and associated in
20% with motor vehicle accidents
or deceleration trauma;
pre-hospital mortality ranges
between 80 and 90% [25].
Without appropriate treatment,
30% of survivors who reach
the hospital die within the first
6 hours. Blunt thoracic aortic
injury involves in 55-90% the
aortic isthmus, in 10-14%
the ascending aorta or aortic
arch and in 15-30% the distal
descending or abdominal aorta
[26]. Aortic disruption is most
of the time (90%) associated
with other life-threatening injuries
with 24% requiring major
surgery before aortic repair
[26]. In this scenario, with open
b
ентов с острой осложненной
диссекцией аорты, чем у пациентов
с хронической аортальной
диссекцией (9,8% против 3,2, и
21,7% против 9,1 соответственно;
p1 см/год) [рис. 5].
Nienaber и соавт. проспективно
изучили ведение 12 пациентов с
установленными графт-стентами
при хронической диссекции аорты
В типа и сравнили их с результатами
хирургического лечения
12 человек контрольной группы
[22]. Пациенты после проксимального
закрытия повреждения
интимы и полного тромбоза
45