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文献：腹部大動脈解離
J Vasc Surg. 2002 Aug;36(2):205-10.
Isolated dissection of the abdominal aorta: clinical presentation and therapeutic options.（自験例10例の検討）
Farber A, Wagner WH, Cossman DV, Cohen JL, Walsh DB, Fillinger MF, Cronenwett JL, Lauterbach SR, Levin PM.
INTRODUCTION: Arterial dissection commonly affects the thoracic aorta and is associated with high morbidity and mortality rates. Although dissection of the abdominal aorta is considered rare, liberal use of diagnostic computed tomographic scan imaging for evaluation of abdominal pain has identified this process with increasing frequency. Because the clinical features and therapeutic options of isolated abdominal aortic dissection are not well characterized, we reviewed our recent experience and provide an algorithm for treatment. PATIENTS AND RESULTS: Since 1996, we have treated 10 patients with abdominal aortic dissection. The mean age was 62 +/- 17 years, and 40% were female. Presentation included abdominal pain in seven patients and lower extremity ischemia in one patient. Dissection was asymptomatic in two of the patients. Hypertension, smoking history, remote trauma, and claudication were noted in four, three, two, and two of the patients, respectively. Three patients had abdominal tenderness, three had a pulsatile mass, and five had a benign abdominal examination. The diagnosis of dissection was made on abdominal computed tomographic scan in eight cases, on arteriogram in one case, and at operation in one case. No patient had an associated thoracic aortic dissection. The dissection flap originated below or at the renal arteries in nine of the cases and at the superior mesenteric artery in one case. Length of the dissection ranged between 21 and 110 mm, and in three patients, the dissection flap extended beyond the aortic bifurcation into the common iliac arteries. In three patients who had an aortogram, evidence of flow limitation was found on the basis of the presence of aortic stenosis or occlusion. Treatment consisted of aortic stent graft deployment in one patient, direct aortic reconstruction in three patients, and observation in the remaining six patients. CONCLUSION: Although the natural history of isolated abdominal aortic dissection has not been well defined, our experience adds to the understanding of this rare process. Because aneurysmal degeneration can occur, close surveillance is indicated if definitive treatment is not used initially. Patients with ischemic symptoms and those with intractable pain need intervention, the nature of which should be based on risk profile and aortoiliac anatomy. PMID: 12170199
２）Semin Vasc Surg. 2002 Jun;15(2):128-36.
Spontaneous dissection of the infrarenal abdominal aorta.（英語文献報告例41例の検討）
Mozes G, Gloviczki P, Park WM, Schultz HL, Andrews JC.
Spontaneous infrarenal abdominal aortic dissection is rare. We observed enlargement of a spontaneous infrarenal aortoiliac dissection in a 55-year-old hypertensive man. Open surgical repair with a bifurcated polyester graft was successful. A review of the English literature found 41 previously published cases. Mean age was 58 years, 74% of the patients were male, and 62% had hypertension. None had Marfan or Ehlers-Danlos syndrome. More than three fourths of the patients had symptoms, 6 patients (14%) presented with aortic rupture. Dissection was limited to the infrarenal aorta in 50% and extended into the iliac or femoral arteries in 50%. Three patients died before treatment, no death occurred after endovascular repair of after elective open aortic grafting. Mortality following rupture was 67%. Abdominal aortic dissection did not reoccur but 1 patient died at 14 month because of rupture of a thoracic aneurysm. Spontaneous infrarenal abdominal aortic dissections are rare, but usually symptomatic and 14% rupture. Rupture carries high mortality. Elective open repair is recommended, but endovascular repair is a new treatment option for suitable patients. PMID: 12060903
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