Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Successful Treatment of Lower Extremity Malperfusion Caused by Acute Aortic Dissection

급성 대동맥 박리증에 의한 하지 관류부전의 치료

  • Lee, Jae-Hoon (Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, Keimyung University College of Medicine) ;
  • Kim, Hyong-Tae (Department of Surgery, Dongsan Medical Center, Keimyung University College of Medicine) ;
  • Kim, Young-Hwan (Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine) ;
  • Choi, Sae-Young (Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, Keimyung University College of Medicine) ;
  • Keum, Dong-Yoon (Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, Keimyung University College of Medicine) ;
  • Park, Nam-Hee (Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, Keimyung University College of Medicine)
  • 이재훈 (계명대학교 의과대학 동산의료원 흉부외과) ;
  • 김형태 (계명대학교 의과대학 동산의료원 외과) ;
  • 김영환 (계명대학교 의과대학 동산의료원 영상의학과) ;
  • 최세영 (계명대학교 의과대학 동산의료원 흉부외과) ;
  • 금동윤 (계명대학교 의과대학 동산의료원 흉부외과) ;
  • 박남희 (계명대학교 의과대학 동산의료원 흉부외과)
  • Published : 2006.12.05
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Abstract

Organ malperfusion may mask the presence of aortic dissection and is one of major cause of death in patient with aortic dissection. Several key mechanism appear to contribute to the development of malperfusion, therefore optimal choosing of treatment is necessary to obtain better result. In cases of extremity malperfusion, open bypass procedures have been used for primary treatment, but noninvasive interventional procedures are also recommended as good alternatives in some cases. Here in, we report a case of successful aortic replacement followed by stent insertion in patient with extremity malperfusion caused by acute aortic dissection.

대동맥 박리증에 의한 관류부전은 진단상의 어려움을 야기할 뿐만 아니라 술 후 환자사망의 주요 원인으로 작용한다. 이러한 관류부전은 여러 가지 기전에 의해 나타나며, 이에 따른 적절한 치료방법의 선택이 환자예후에 중요한 영향을 미친다. 사지 관류부전의 경우 통상적으로 혈관 우회술이 주로 사용되어졌으나, 비침습적인 중재술이 하나의 좋은 치료방법으로 대두되고 있다. 저자들은 급성 대동맥 박리증에 의한 하지 관류부전 환자에서 대동맥치환술에 이은 스텐트 삽입술로 좋은 결과를 얻었기에 문헌과 함께 보고한다.

Keywords

References

  1. Girardi LN, Krieger KH, Lee LY, Mack CA, Tortolani AJ, Isom OW. Management Strategies for type A dissection complicated by peripheral vascular malperfusion. Ann Thorac Surg 2004;77:1309-14 https://doi.org/10.1016/j.athoracsur.2003.09.056
  2. Slonim SM, Miller DC, Mitchell RS, Semba CP, Razavi MK, Kake MD. Percutaneous balloon fenestration and stenting for life-threatening ischemic complications in patients with acute aortic dissection. J Thorac Cardiovasc Surg 1999; 117:1118-27 https://doi.org/10.1016/S0022-5223(99)70248-5
  3. Sandridge L, Kern JA. Acute desceding aortic dissections: management of visceral, spinal cord, and extremity malperfusion. Semin Thorac Cardiovasc Surg 2005;17:256-61 https://doi.org/10.1053/j.semtcvs.2005.06.003
  4. Vedantham S, Picus D, Sanchez LA, et al. Percutaneous management of ischemic complications in patients with type-B aortic dissection. J Vasc Interv Radiol 2003;14:181-93 https://doi.org/10.1097/01.RVI.0000058320.82956.3f
  5. Tsai TT, Neinaber CA, Eagle KA. Acute aortic syndromes. Circulation 2005;112:3802-13H https://doi.org/10.1161/CIRCULATIONAHA.105.534198
  6. You JH, Park KH, Park PW, et al. Successful treatment of organ malperfusion caused by acute aortic dissection. Korean J Thorac Cardiovasc Surg 2003;36:194-201
  7. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 2006;113:e463-654 https://doi.org/10.1161/CIRCULATIONAHA.106.174526
  8. Adam DJ, Beard JD, Cleveland T, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet 2005;366:1925-34 https://doi.org/10.1016/S0140-6736(05)67704-5