Abou-Zamzam Ahmed M, Zhang Wayne, Wang Nan, Razzouk Anees
Division of Vascular Surgery, Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA.
Ann Vasc Surg. 2008 Mar;22(2):168-72. doi: 10.1016/j.avsg.2007.09.001.
Endovascular repair of the thoracic aorta is now widely practiced. The extension of this technique to emergent settings is in evolution. Pathology of the ascending and transverse aortic arch may preclude thoracic aortic stent grafting due to the lack of a proximal seal zone. Several hybrid open/endovascular approaches have been described. We recently encountered the difficult case of a contained rupture of a 6.8 cm descending thoracic aortic aneurysm in a 60-year-old patient with aneurysmal degeneration of the ascending and transverse aortic arch. This patient was treated with a hybrid approach of open ascending and transverse arch reconstruction along with simultaneous stent-graft repair of the descending thoracic aorta. The open repair established an excellent proximal landing zone by use of the "elephant trunk" technique. This technique also allowed direct suture fixation of the stent graft to the arch graft to prevent stent-graft migration. This hybrid surgical approach was successful and avoided the cumulative morbidity that a left thoracoabdominal approach would have added to the sternotomy. Further creative uses of these hybrid techniques will undoubtedly serve a larger role in the treatment of thoracic aortic pathology.
胸主动脉腔内修复术目前已广泛应用。将该技术扩展至急诊情况仍在不断发展。升主动脉和主动脉弓横部的病变可能因缺乏近端密封区而妨碍胸主动脉支架植入。已有多种开放/腔内杂交手术方式被描述。我们最近遇到一例困难病例，一名60岁患有升主动脉和主动脉弓横部动脉瘤样退变的患者，其6.8 cm降主动脉瘤发生了局限性破裂。该患者接受了开放升主动脉和主动脉弓横部重建并同时行降主动脉支架植入修复的杂交手术方式。开放修复通过使用“象鼻”技术建立了优良的近端锚定区。该技术还允许将支架移植物直接缝合固定于主动脉弓移植物，以防止支架移植物移位。这种杂交手术方式取得了成功，避免了左胸腹联合切口可能给胸骨切开术带来的累积并发症。这些杂交技术的进一步创新性应用无疑将在胸主动脉病变的治疗中发挥更大作用。
