PDF(Pubmed)
Abstract：
Aortic intramural hematoma (IMH) accounts for approximately 10%-25% of acute aortic syndromes (AAS), and multi-slice computed tomography and magnetic resonance imaging are the leading techniques for diagnosis and classification. In this context, endovascular strategies provide a valid alternative to traditional open surgery and transesophageal echocardiography (TEE) could play a role in therapeutic decision-making and in endovascular repair procedure guidance. A 57-year-old female patient with IMH extending from the left subclavian artery to the upper tract of the abdominal aorta, underwent endovascular aortic repair using an unibody single-branched stent grafting in the aortic arch and descending aorta with a side branch inserted in the left common carotid artery. To restore proper flow in the left axillary artery, a carotid-subclavian bypass graft was performed. The procedure was guided by angiography and TEE. Intraoperative TEE revealed aortic IMH with a significant fluid component in the middle tunic of the aorta with a wall thickness of over 13 mm. TEE was useful in monitoring of all steps of the procedure, showing the presence of the guidewires into the true lumen, the advancement of the prosthesis, and the phases of release and anchoring. This case highlights the importance of using multimodality imaging techniques to evaluate AAS and demonstrates the growing potential of TEE in guiding endovascular repairs.
摘要：
主动脉壁间血肿（IMH）约占急性主动脉综合征（AAS）的10％-25％，多层计算机断层扫描和磁共振成像是诊断和分类的主要技术。在这种情况下，血管内治疗策略提供了传统开放手术的有效替代方案,经食管超声心动图(TEE)可在治疗决策和血管内修复手术指导中发挥作用.一名57岁的女性IMH患者，从左锁骨下动脉延伸至腹主动脉上束，在主动脉弓和降主动脉中使用单体单分支支架移植术,并在左颈总动脉中插入侧支,接受了血管内主动脉修复术.为了恢复左腋窝动脉的正常血流，进行颈动脉锁骨下旁路移植术.该过程由血管造影和TEE引导。术中TEE显示主动脉IMH在主动脉中膜中具有明显的液体成分，壁厚超过13mm。TEE可用于监控程序的所有步骤，显示导丝进入真腔的存在，假肢的进步，以及释放和锚定的阶段。此案例强调了使用多模态成像技术评估AAS的重要性，并证明了TEE在指导血管内修复方面的潜力。
