Akasaka Junetsu, Tabayashi Koichi, Saiki Yoshikatsu, Oda Katsuhiko, Kumagai Kiichiro, Iguchi Atsushi
Department of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai City, Miyagi Prefecture, 980-8574, Japan.
Eur J Cardiothorac Surg. 2005 Apr;27(4):649-53. doi: 10.1016/j.ejcts.2004.12.040.
Although several methods of stent-grafting for patients with aortic arch aneurysm have been reported, these methods have been associated with several complications such as endoleak and migration. We developed a new method using Matsui-Kitamura (MK) stent-graft following extra-anatomic arch vessels bypass by selective cerebral perfusion (SCP) under left heart bypass (LHB).
Between December 2001 and December 2003, 12 patients with aortic arch aneurysm were treated according to this new method. All patients were male with an average age of 71.3+/-6.4 years. There were 5 patients with severe pulmonary dysfunction, 4 with renal dysfunction, one with severe cardiac dysfunction and 3 with preoperative cerebral infarction. Under SCP using LHB, the extra-anatomic arch vessel bypass was established. The MK stent-graft was delivered into the aortic arch. Coronary artery bypass grafting (CABG) was concomitantly performed in one patient.
There were no cases of endoleak, migration or hospital death. One patient, who had a past history of cerebrovascular disease, suffered a minor stroke, and one patient, who was performed CABG to the mid-left anterior descending branch (LAD) using the left internal thoracic artery (LITA), presented paraparesis. Although two patients of chronic renal failure underwent scheduled CHDF on account of using the contrast medium during the procedure, all of them were weaned from hemodialysis. However, there were no other postoperative complications such as, respiratory failure or cardiac dysfunction.
Endovascular stent grafting EVSG using the MK stent with extra-anatomic arch vessel bypass under SCP using LHB could be a useful and less invasive method for patients with aortic arch aneurysm who are at a high surgical risk.
虽然已经报道了几种用于治疗主动脉弓动脉瘤患者的支架植入方法，但这些方法都伴随着诸如内漏和移位等多种并发症。我们开发了一种新方法，即在左心转流（LHB）下通过选择性脑灌注（SCP）建立解剖外弓血管旁路后，使用松井 - 北村（MK）支架移植物。
在2001年12月至2003年12月期间，12例主动脉弓动脉瘤患者按照这种新方法接受了治疗。所有患者均为男性，平均年龄为71.3±6.4岁。其中5例有严重肺功能障碍，4例有肾功能障碍，1例有严重心功能障碍，3例有术前脑梗死。在LHB辅助下进行SCP，建立解剖外弓血管旁路。将MK支架移植物输送至主动脉弓。1例患者同时进行了冠状动脉旁路移植术（CABG）。
无内漏、移位或院内死亡病例。1例有脑血管疾病史的患者发生轻度中风，1例使用左乳内动脉（LITA）对左前降支（LAD）中段进行CABG的患者出现下肢轻瘫。虽然2例慢性肾衰竭患者因术中使用造影剂而接受了计划性连续性血液透析滤过（CHDF），但所有患者均成功脱离血液透析。然而，没有出现其他术后并发症，如呼吸衰竭或心功能障碍。
对于手术风险高的主动脉弓动脉瘤患者，在LHB辅助下SCP时使用MK支架并结合解剖外弓血管旁路进行血管内支架植入术（EVSG）可能是一种有用且侵入性较小的方法。
