Aortic fenestration: A why, when, and how-to guide
Aortic fenestration: A why, when, and how-to guide
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DOI：
10.1148/rg.251045078
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发表时间：
2005-01-01
期刊：
影响因子：
5.5
通讯作者：
Gates, J
中科院分区：
文献类型：
--
作者：
Hartnell, GG;Gates, J
主动脉夹层的治疗具有挑战性。大多数急性A型夹层的病例都是手术治疗。大多数急性B型夹层病例采用药物治疗，但有时也行开放手术或覆膜支架置入术。患有B型或手术治疗的A型夹层的患者可能会发生血管并发症，如肠系膜或外周缺血，这些并发症无法通过药物治疗。主动脉开窗术是一种通过在夹层瓣的远端部分创建一个孔来减压高血压假腔的方法。该手术允许从假腔流出，从而降低腔内压力，缓解分支血管阻塞，并降低夹层扩展的风险。需要紧急血运重建以纠正肠系膜和肾脏缺血，并在存在静息缺血时重建远端灌注。很少有术者获得经皮主动脉开窗术的丰富个人经验。尽管如此，只要对病理状况有很好的了解，仔细演示解剖结构，良好的技术技能，并获得高质量的成像（包括血管内超声检查）和必要的设备，大多数熟悉动脉介入的介入放射科医生应该能够执行此程序。然而，由于经常需要进一步的干预，放射科医生需要与患者保持联系，以确保及时治疗任何后续并发症。(C)RSNA，2005年。
The management of aortic dissection can be challenging. Most cases of acute type A dissection are managed surgically. Most cases of acute type B dissection are managed medically, although open surgery or stent-graft placement is sometimes performed. Patients with type B or surgically treated type A dissection may develop vascular complications such as mesenteric or peripheral ischemia, which cannot be managed medically. Aortic fenestration is a method for decompressing the hypertensive false lumen by creating a hole in the distal part of the dissection flap. This procedure allows outflow from the false lumen, thereby reducing intraluminal pressure, relieving branch vessel obstruction, and reducing the risk of extension of the dissection. Urgent revascularization is required to correct mesenteric and renal ischemia and to reestablish distal perfusion if there is resting ischemia. Few operators will acquire extensive personal experience with percutaneous aortic fenestration. Nevertheless, with a good understanding of the pathologic condition, careful demonstration of the anatomy, good technical skills, and access to high-quality imaging (including intravascular ultrasonography) and the requisite equipment, most interventional radiologists skilled in arterial interventions should be capable of performing this procedure. However, because further interventions are frequently required, the radiologist needs to maintain contact with the patient to ensure timely treatment of any subsequent complications. (C) RSNA, 2005.