Schönholz Claudio, Ikonomidis John S, Hannegan Christopher, Mendaro Esteban
Heart and Vascular Center, Medical University of South Carolina, Charleston, SC 29425, USA.
J Endovasc Ther. 2008 Dec;15(6):639-42. doi: 10.1583/08-2507.1.
To report the use of an external common femoral to carotid artery shunt in the setting of acute type A aortic dissection associated with carotid occlusion and stroke.
The procedure is illustrated in a 52-year-old man who presented with a type A dissection extending into the innominate trunk, with associated occlusion of the right common carotid artery (CCA). Angiography showed no collateral circulation to the right cerebral hemisphere. To re-establish brain perfusion in this setting, a percutaneous external shunt was installed from the common femoral artery to the right CCA. The 5-F femoral sheath used during diagnostic angiography was replaced by an 8-F femoral introducer securely fixed to the skin with silk sutures. Ultrasound-guided percutaneous CCA access was obtained using an 18-G needle and a 6-F introducer, also sutured to the skin. The ICA and intracranial branches showed no evidence of thrombosis at this level. A plastic tube was used to connect the femoral and carotid sheath side arms to restore ICA flow. Transcranial Doppler showed normal flow at the right middle cerebral artery after shunt placement. The patient was immediately transferred to the operating room for aortic surgery, during which an intrapericardially ruptured aorta was found. The ascending aorta and proximal arch were replaced under cardiopulmonary bypass and circulatory arrest, but the patient died during the procedure due to uncontrolled bleeding.
A temporary percutaneous external femoral-carotid shunt can restore blood flow to the brain whenever the carotid artery is occluded by the dissection flap and adequate collateral flow is absent.
报告在伴有颈动脉闭塞和中风的急性A型主动脉夹层病例中使用股总动脉至颈动脉外分流术的情况。
在一名52岁男性患者中展示了该手术过程，该患者患有延伸至无名动脉干的A型夹层，伴有右颈总动脉（CCA）闭塞。血管造影显示右侧大脑半球无侧支循环。为在此情况下重建脑灌注，经皮从股总动脉至右CCA安装了一个外分流装置。诊断性血管造影期间使用的5F股鞘被一个8F股导入器取代，并用丝线缝合牢固固定于皮肤上。使用18G穿刺针和6F导入器在超声引导下经皮穿刺进入CCA，同样缝合固定于皮肤上。在此水平，颈内动脉（ICA）及其颅内分支未显示血栓形成迹象。使用一根塑料管连接股鞘和颈动脉鞘的侧臂以恢复ICA血流。分流装置置入后经颅多普勒显示右大脑中动脉血流正常。患者立即被转至手术室进行主动脉手术，术中发现心包内主动脉破裂。在体外循环和循环停止下替换升主动脉和近端主动脉弓，但患者在手术过程中因出血无法控制而死亡。
当颈动脉被夹层瓣阻塞且缺乏足够的侧支血流时，临时性经皮股-颈动脉外分流术可恢复脑血流。
