Yanaka Kiyoyuki, Meguro Kotoo, Nose Tadao
Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan.
Neurosurgery. 2002 Jan;50(1):218-21. doi: 10.1097/00006123-200201000-00037.
An aneurysm can produce large defects in the parent vessel if the aneurysm tears at the neck of the vessel. The authors present a technique to repair a tear at the base of a blister-like aneurysm encountered during microsurgical clipping of an anterior wall aneurysm of the internal carotid artery.
The repair technique involved suturing and covering the aneurysm with an encircling aneurysm clip. A large tear had destroyed the vessel's tubular structure, and repair was not sufficient using an encircling clip alone. Two microsuture stitches were placed on the tear, so that a split artery re-formed a tubular structure. The lesion was then covered with Surgicel (Ethicon, Inc., Somerville, NJ) and fibrin glue. When the Surgicel and fibrin glue were applied, the temporary clip on the distal internal carotid artery was removed for a moment, allowing retrograde blood flow to provide the counterforce necessary to maintain the vessel's tubular structure. An encircling clip was then applied to cover the entire circumference of the lesion.
This method required only a short occlusion time for arterial repair, thus helping avoid ischemic complications. The patient awoke with transient hemiparesis, but recovery was prompt.
This technique is useful for repairing an aneurysmal tear at its base, especially if the tear is large.
如果动脉瘤在血管颈部撕裂，可导致载瘤血管出现大的缺损。作者介绍一种在显微手术夹闭颈内动脉前壁动脉瘤时遇到的泡状动脉瘤底部撕裂的修复技术。
修复技术包括用环绕动脉瘤夹缝合并覆盖动脉瘤。一个大的撕裂破坏了血管的管状结构，仅使用环绕夹修复是不够的。在撕裂处放置两针显微缝线，使裂开的动脉重新形成管状结构。然后用速即纱（强生公司，新泽西州萨默维尔）和纤维蛋白胶覆盖病变部位。应用速即纱和纤维蛋白胶时，暂时松开颈内动脉远端的夹子片刻，使逆行血流提供维持血管管状结构所需的反作用力。然后应用环绕夹覆盖病变的整个圆周。
该方法仅需短暂的动脉修复阻断时间，有助于避免缺血性并发症。患者苏醒时出现短暂性偏瘫，但恢复迅速。
该技术对于修复动脉瘤底部的撕裂，尤其是大的撕裂很有用。
