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中华普通外科学文献(电子版) ›› 2024, Vol. 18 ›› Issue (05) : 335 -337. doi: 10.3877/cma.j.issn.1674-0793.2024.05.004

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主动脉内膜脱套诊治体会
朱锋1, 戈小虎1,()   
  1. 1. 830001 乌鲁木齐,新疆维吾尔自治区人民医院血管外科
  • 收稿日期:2024-04-28 出版日期:2024-10-01
  • 通信作者: 戈小虎

Diagnosis and treatment of aortic intimo-intimal intussusception

Feng Zhu, Xiaohu Ge()   

  • Received:2024-04-28 Published:2024-10-01
  • Corresponding author: Xiaohu Ge
引用本文:

朱锋, 戈小虎. 主动脉内膜脱套诊治体会[J]. 中华普通外科学文献(电子版), 2024, 18(05): 335-337.

Feng Zhu, Xiaohu Ge. Diagnosis and treatment of aortic intimo-intimal intussusception[J]. Chinese Archives of General Surgery(Electronic Edition), 2024, 18(05): 335-337.

早在1887年,Bostroem首次报道了主动脉夹层存在一种特殊类型:环形夹层,内膜呈环状撕脱。1962年Hufnagel将这种并发症命名为"主动脉内膜脱套"(aortic intimo-intimal intussusception,AII)[1],并通过8例患者的总结分析,将其特征归纳为:(1)内膜的环状撕裂位于冠状动脉开口上方;(2)在升主动脉至无名动脉水平,内膜与中膜呈环状分离;(3)内膜脱套入血管腔内,并可延伸至降主动脉;(4)脱套的主动脉内膜可能会造成分支动脉阻塞;(5)夹层可逆撕至主动脉瓣处[1]

图1 主动脉脱套的分型 Ⅰ为顺行型,Ⅱ为逆行型,Ⅲ为双向型(图片参考文献[1])
图2 真腔塌陷,主动脉弓部内膜脱套状改变
图3 近端真腔呈鸟嘴状改变
图4 真腔开放,远端血流恢复
图5 降主动脉中段起真腔塌陷
图6 肠系膜上动脉上方真腔消失
图7 CTA提示患者无灌注不良
图8 支架末端造影:"风向袋征"
图9 造影见真腔开放
[1]
Hufnagel CA, Conrad PW. Intimo-intimal intussusception in dissecting aneurysms[J]. Am J Surg, 1962, 103: 727-731.
[2]
Wu ZY, Miao YQ, Knappich C, et al. Aortic intimo-intimal intussusception: A pooled analysis of published reports[J]. Ann Vasc Surg, 2021, 75: 471-478.
[3]
Wu ZY, Li P, Wang JY, et al. Aortic intimal intussusception during acute type B aortic dissection endovascular repair[J]. Ann Transl Med, 2019, 7(22): 700.
[4]
Li J, Li Q, Shu C. Aortic intimal intussusception induced by stent-graft during endovascular repair of acute type B aortic dissection[J]. Eur Heart J, 2023, 44(45): 4813.
[5]
Havelka GE, Tomita TM, Malaisrie SC, et al. Two cases of aortic intimal intussusception during endovascular repair of an acute type B dissection[J]. J Endovasc Ther, 2016, 23(3): 521-528.
[6]
Ma T, Liu F, Chen B, et al. Intraoperative stent-graft-induced aortic intimal intussusception during TEVAR for type B aortic dissection[J]. J Endovasc Ther, 2021, 28(6): 860-870.
[7]
Ibrahim M, Rashid J, Kurtz SC, et al. The telescoping aorta: A case of circumferential aortic dissection with intimo-intimal intussusception into the left ventricle[J]. BMJ Case Rep, 2017: bcr2017221399.
[8]
Sanchez OR, Ibanez MD, Salceda AJ, et al. Circumferential type A aortic dissection with intimal intussusception[J]. J Cardiovasc Comput Tomogr, 2015, 9(5): 459-460.
[9]
von Aspern K, Etz CD, Lehmkuhl L, et al. A rare pattern of acute type A aortic dissection: circumferential intimal invagination[J]. Thorac Cardiovasc Surg, 2012, 60(8): 552-554.
[10]
Kim SY, Hwang HY, Lee W, et al. Aortic intimointimal intussusception in chronic type B dissection causing dynamic obstruction of visceral arteries[J]. J Thorac Cardiovasc Surg, 2015, 150(3): e33-e35.
[11]
Kalsi R, Drucker CB, Salazar JH, et al. Blunt multifocal aortic injury with abdominal aortic intimointimal intussusception[J]. J Vasc Surg Cases Innov Tech, 2018, 4(1): 37-40.
[12]
Yanase Y, Ohkawa A, Inoue S, et al. Stanford type A acute aortic dissection with intimal intussusception[J]. Ann Thorac Cardiovasc Surg, 2020, 26(1): 51-54.
[13]
Nienaber CA, Kische S, Zeller T, et al. Provisional extension to induce complete attachment after stent-graft placement in type B aortic dissection: the PETTICOAT concept[J]. J Endovasc Ther, 2006, 13(6): 738-746.
[14]
Roberts WC, Kapoor P, Main ML, et al. Acute aortic dissection with intussusception of the partition between the true and false channels leading to near total aortic occlusion (true aortic stenosis)[J]. Am J Cardiol, 2017, 119(2): 340-344.
[15]
Ma T, Dong ZH, Fu WG, et al. Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair[J]. J Vasc Surg, 2018, 67(4): 1026-1033.
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