Abstract：
UNASSIGNED: Masquerade presentation of acute type B aortic dissections (TBAD) as acute limb ischaemia (ALI) is rare. Holistic clinical assessment, preferably with the help of scoring systems and timely computer tomographic angiogram (CTA), is needed for early diagnosis. Acute TBAD and its complications are increasingly treated with endovascular therapies.
METHODS: A 21-year-old male with poorly controlled essential hypertension was admitted with prominent clinical features of ALI. No clinical pointers of a TBAD were present. Doppler ultrasound revealed an arterial occlusive pattern, and an urgent surgical embolectomy was performed. On failure to retrieve any thrombi, a CTA was performed, and diagnosis of TBAD complicated with ALI was made. The limb was revascularised with guidewire directed aortic fenestration with angioplasty. TBAD was managed conservatively.
UNASSIGNED: We report a case of acute TBAD presented as isolated ALI, which was initially diagnosed and treated as an ALI unrelated to aortic dissection. TBAD with typical or atypical clinical features presented with ALI as a malperfusion syndrome is not uncommon. However, masquerade presentations of TBAD as ALI are rare in the literature. Endovascular fenestration with or without stenting has fewer neurological complications and long-term mortality than thoracic endovascular aortic repair (TEVAR). Moreover, they become convenient in resource-poor settings without dedicated aortic centres.
CONCLUSIONS: Masquerade presentation of TBAD should be recognised in the differential diagnosis of ALI. Timely CTA would prevent unnecessary interventions and help diagnose TBAD complicated with ALI. Despite their availability, outcomes will depend on proper patient selection for endovascular, surgical, and TEVAR options.
METHODS: A 21-year-old male with poorly controlled essential hypertension was admitted with prominent clinical features of ALI. No clinical pointers of a TBAD were present. Doppler ultrasound revealed an arterial occlusive pattern, and an urgent surgical embolectomy was performed. On failure to retrieve any thrombi, a CTA was performed, and diagnosis of TBAD complicated with ALI was made. The limb was revascularised with guidewire directed aortic fenestration with angioplasty. TBAD was managed conservatively.
UNASSIGNED: We report a case of acute TBAD presented as isolated ALI, which was initially diagnosed and treated as an ALI unrelated to aortic dissection. TBAD with typical or atypical clinical features presented with ALI as a malperfusion syndrome is not uncommon. However, masquerade presentations of TBAD as ALI are rare in the literature. Endovascular fenestration with or without stenting has fewer neurological complications and long-term mortality than thoracic endovascular aortic repair (TEVAR). Moreover, they become convenient in resource-poor settings without dedicated aortic centres.
CONCLUSIONS: Masquerade presentation of TBAD should be recognised in the differential diagnosis of ALI. Timely CTA would prevent unnecessary interventions and help diagnose TBAD complicated with ALI. Despite their availability, outcomes will depend on proper patient selection for endovascular, surgical, and TEVAR options.
摘要：
未经证实：假扮出现急性肢体缺血（ALI）的急性B型主动脉夹层（TBAD）很少见。整体临床评估，最好在评分系统和及时的计算机断层造影血管造影（CTA）的帮助下，是早期诊断所需要的。急性TBAD及其并发症越来越多地采用血管内治疗。
方法：一名21岁男性高血压患者因ALI的临床特征明显而入院。不存在TBAD的临床指针。多普勒超声显示动脉闭塞模式,并进行了紧急手术栓子切除术。在未能取回任何血栓的情况下，进行了CTA,诊断为TBAD合并ALI。用导丝引导的主动脉瓣开窗术和血管成形术对肢体进行血运重建。TBAD管理保守。
未经证实：我们报告一例急性TBAD，表现为孤立性ALI，最初诊断为与主动脉夹层无关的ALI。具有典型或非典型临床特征的TBAD，以ALI为灌注不良综合征并不少见。然而,TBAD伪装成ALI在文献中很少见。与胸主动脉腔内修复术（TEVAR）相比，有或没有支架的血管内开窗术具有更少的神经系统并发症和长期死亡率。此外，在没有专门的主动脉中心的资源贫乏的环境中,它们变得方便.
结论：在ALI的鉴别诊断中应认识到TBAD的假象表现。及时CTA可以防止不必要的干预，并有助于诊断TBAD并发ALI。尽管他们的可用性，结果将取决于血管内的正确患者选择，外科,和TEVAR选项。
方法：一名21岁男性高血压患者因ALI的临床特征明显而入院。不存在TBAD的临床指针。多普勒超声显示动脉闭塞模式,并进行了紧急手术栓子切除术。在未能取回任何血栓的情况下，进行了CTA,诊断为TBAD合并ALI。用导丝引导的主动脉瓣开窗术和血管成形术对肢体进行血运重建。TBAD管理保守。
未经证实：我们报告一例急性TBAD，表现为孤立性ALI，最初诊断为与主动脉夹层无关的ALI。具有典型或非典型临床特征的TBAD，以ALI为灌注不良综合征并不少见。然而,TBAD伪装成ALI在文献中很少见。与胸主动脉腔内修复术（TEVAR）相比，有或没有支架的血管内开窗术具有更少的神经系统并发症和长期死亡率。此外，在没有专门的主动脉中心的资源贫乏的环境中,它们变得方便.
结论：在ALI的鉴别诊断中应认识到TBAD的假象表现。及时CTA可以防止不必要的干预，并有助于诊断TBAD并发ALI。尽管他们的可用性，结果将取决于血管内的正确患者选择，外科,和TEVAR选项。
