Rampoldi Vincenzo, Trimarchi Santi, Righini Paolo, Tolva Valerio, Inglese Luigi
Department of Vascular Surgery, Istituto Policlinico San Donato, San Donato Milanese, Italy.
Ann Thorac Surg. 2004 Sep;78(3):1075-8. doi: 10.1016/j.athoracsur.2004.03.047.
A surgical technique of endovascular graft explant through an open aortic approach for left hemi-arch stent-graft failure is described. Between January and April 2003, we surgically treated 3 patients previously submitted for stent grafts for isthmic aortic diseases. Two patients had atherosclerotic aneurysm and 1 had a false lumen reperfusion of subacute intramural hematoma. At 6 to 8 months computed tomographic scan follow-ups on all patients showed a rapid enlargement of aortic diameters due to type I endoleaks. The presence of an uncovered proximal stent in the parasubclavian aorta did not allow a simple aortic cross clamping; therefore we performed an open aortic procedure through a left posterolateral thoracotomy, using femoro-femoral bypass and mild hypothermic circulatory arrest. Selective antegrade cerebral perfusion was started within 3 to 5 minutes from aortotomy and graft removal. Left hemi-arch and descending thoracic aortic replacement was then performed with continuous cerebral perfusion. No surgical mortality was observed. Postoperative course was uneventful for neurologic, cardiac, respiratory, and renal complications. The 3-month follow-ups were event free. This approach, associated with rapid stent-graft explant and selective cerebral antegrade perfusion, appears to be a safe and effective surgical strategy for treating this new aortic pathology.
描述了一种通过开放主动脉入路取出血管内移植物治疗左半弓支架型人工血管失败的外科技术。2003年1月至4月期间，我们对3例先前因峡部主动脉疾病接受支架型人工血管治疗的患者进行了手术治疗。2例患者患有动脉粥样硬化性动脉瘤，1例患者为亚急性壁内血肿假腔再灌注。所有患者在6至8个月的计算机断层扫描随访中均显示由于I型内漏导致主动脉直径迅速增大。锁骨下主动脉近端支架未覆盖，无法进行简单的主动脉交叉钳夹；因此，我们通过左后外侧开胸进行开放主动脉手术，采用股-股旁路和轻度低温循环停止。在主动脉切开和移植物取出后3至5分钟内开始选择性顺行脑灌注。然后在持续脑灌注下进行左半弓和降主动脉置换。未观察到手术死亡。术后神经、心脏、呼吸和肾脏并发症的病程平稳。3个月随访无异常。这种方法与快速取出支架型人工血管和选择性脑顺行灌注相关，似乎是治疗这种新的主动脉病变的一种安全有效的手术策略。
