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新型内脏吻合优先法用于开放性修复破裂的Ⅱ型胸腹主动脉瘤：死亡结局背后的原因

Novel Visceral-Anastomosis-First Approach in Open Repair of a Ruptured Type 2 Thoracoabdominal Aortic Aneurysm: Causes behind a Mortal Outcome.

作者信息

Dregelid Einar, Daryapeyma Alireza

机构信息

Department of Vascular Surgery, Haukeland University Hospital, Jonas Lies Vei 65, 5021 Bergen, Norway.

出版信息

Case Rep Vasc Med. 2013;2013:978625. doi: 10.1155/2013/978625. Epub 2013 Feb 17.

DOI:10.1155/2013/978625
PMID:23476885
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3588210/
Abstract

Case reports to analyze causes and possible prevention of complications in a new setting are important. We present an open repair of a ruptured type 2 thoracoabdominal aortic aneurysm in a 78-year-old man. Lower-body perfusion through a temporary extracorporeal axillobifemoral arterial prosthesis shunt was combined with the use of a branch to the permanent aortic prosthesis to enable rapid visceral revascularization using a visceral-anastomosis-first approach. The patient died due to transfusion-induced capillary leak syndrome and left colon necrosis; the latter was probably caused by a combination of back-bleeding from lumbar arteries causing a steal effect, an accidental shunt obstruction, and hemodynamic instability towards the end of the operation. The visceral-anastomosis-first approach did not contribute to the complications. This approach reduces the time when visceral organs are perfused only via collateral arteries to the time needed for suturing the visceral anastomoses. This may be important when collateral perfusion is marginal.

摘要

分析新环境下并发症原因及可能预防措施的病例报告很重要。我们报告了一例78岁男性2型胸腹主动脉瘤破裂的开放修复手术。通过临时体外腋双股动脉人工血管分流进行下半身灌注，并结合使用分支连接永久性主动脉人工血管，采用先进行内脏吻合的方法实现快速内脏血管重建。患者因输血引起的毛细血管渗漏综合征和左结肠坏死死亡；后者可能是由于腰动脉回血导致盗血效应、意外分流阻塞以及手术末期血流动力学不稳定共同作用所致。先进行内脏吻合的方法与并发症无关。这种方法将内脏器官仅通过侧支动脉灌注的时间缩短至缝合内脏吻合所需的时间。当侧支灌注不足时，这可能很重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/df1f/3588210/c2c3f00b72c0/CRIM.VASMED2013-978625.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/df1f/3588210/51393dde14a9/CRIM.VASMED2013-978625.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/df1f/3588210/eeeb8316e892/CRIM.VASMED2013-978625.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/df1f/3588210/c2c3f00b72c0/CRIM.VASMED2013-978625.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/df1f/3588210/51393dde14a9/CRIM.VASMED2013-978625.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/df1f/3588210/eeeb8316e892/CRIM.VASMED2013-978625.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/df1f/3588210/c2c3f00b72c0/CRIM.VASMED2013-978625.003.jpg

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本文引用的文献

1
Elective sac perfusion to reduce the risk of neurologic events following endovascular repair of thoracoabdominal aneurysms.择期行腹主动脉瘤腔内修复术后的选择性内脏动脉灌注以降低神经系统事件的风险。
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Spinal cord preservation in thoracoabdominal aneurysm repair.
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Fenestrated grafts or debranching procedures for complex abdominal aortic aneurysms.用于复杂腹主动脉瘤的开窗移植物或去分支手术。
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Intraoperative skeletal muscle ischemia contributes to risk of renal dysfunction following thoracoabdominal aortic repair.术中骨骼肌缺血会增加胸腹主动脉修复术后肾功能不全的风险。
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The adverse effect of back-bleeding from lumbar arteries on spinal cord pathophysiology in a rabbit model.兔模型中腰动脉回血对脊髓病理生理学的不良影响。
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[Comparative description of approaches in surgical treatment of aneurysms of descending thoracic aorta].[胸降主动脉瘤手术治疗方法的比较描述]
Khirurgiia (Mosk). 2004(8):17-21.
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[Collateral circulation of the left colon: historic considerations and actual clinical significance].[左半结肠的侧支循环：历史考量与实际临床意义]
Chirurg. 2003 Jun;74(6):575-8. doi: 10.1007/s00104-003-0634-6.
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How I do it: thoracoabdominal aortic aneurysm graft replacement.我的做法：胸腹主动脉瘤移植置换术。
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Thoracoabdominal aortic aneurysm. How we do it.胸腹主动脉瘤。我们是如何进行治疗的。
Cardiovasc Surg. 1999 Oct;7(6):593-6. doi: 10.1016/s0967-2109(99)00037-x.