Marty Bettina, Morales Carine Chapuis, Tozzi Piergiorgio, Ruchat Patrick, Chassot Pierre-Guy, von Segesser Ludwig Karl
Department of Cardiovascular Surgery, University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
J Endovasc Ther. 2004 Apr;11(2):175-9. doi: 10.1583/03-1106.1.
To present a maneuver consisting of temporary blockage of the venous return to the heart for accurate deployment of thoracic aortic endoprostheses.
During endovascular repairs in the thoracic aorta, an occluding balloon was introduced through the femoral vein into the right atrium under transesophageal echocardiographic control. The venous return through the inferior vena cava was temporarily blocked to reduce aortic flow during device deployment. The technique was applied in 21 patients with various lesions of the thoracic aorta. Partial inflow occlusion resulted in a mean systolic pressure of 49+/-6 mmHg and lasted for 52+/-14 seconds. Cardiac function was comparable to the preocclusion state, and no arrhythmias or ischemic events were encountered. In 7 procedures, inotropic or vasoconstrictor support was necessary after deployment. No complications related to the venous system were observed. The endoprostheses were precisely deployed at the target site in all patients.
The force of aortic flow often impairs precise deployment of thoracic endoprostheses, resulting in distal displacement. Partial inflow occlusion provides precise control over the extent and duration of the hypotensive period, allowing accurate deployment of thoracic endoprostheses.
介绍一种通过临时阻断心脏静脉回流来精确部署胸主动脉腔内修复器械的操作方法。
在胸主动脉腔内修复术中，在经食管超声心动图引导下，将封堵球囊经股静脉置入右心房。临时阻断下腔静脉的静脉回流，以在器械部署期间减少主动脉血流。该技术应用于21例患有各种胸主动脉病变的患者。部分入流阻断导致平均收缩压为49±6 mmHg，持续时间为52±14秒。心功能与阻断前状态相当，未出现心律失常或缺血事件。在7例手术中，部署后需要使用正性肌力药物或血管收缩剂支持。未观察到与静脉系统相关的并发症。所有患者的腔内修复器械均精确部署在目标部位。
主动脉血流的力量常常会妨碍胸主动脉腔内修复器械的精确部署，导致其向远端移位。部分入流阻断可精确控制低血压期的程度和持续时间，从而实现胸主动脉腔内修复器械的精确部署。
