Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Ann Cardiothorac Surg. 2013 May;2(3):369-71. doi: 10.3978/j.issn.2225-319X.2013.05.13.
The advances in thoracic endovascular aortic repair (TEVAR) offer patients who are otherwise unsuitable for open surgery an alternative in treating their aortic arch pathologies. However, the adoption of TEVAR carries inherent complications unique to itself, notably the occurrence of Type A retrograde ascending aortic dissections, which can range from 1-3%. Several key technical considerations are must be heeded to minimize the risks of these complications. It is important to completely excise the primary entry tear through a careful and methodical approach. The proximal and distal reconstruction must be hemodynamically sound, with care taken to stabilize both the root and the distal aorta. Neuroprotection strategies, such as antegrade cerebral perfusion, should be utilized if the duration of circulatory arrest is anticipated to be greater than 30 minutes. This report details the operative techniques for the repair of retrograde aortic dissections following TEVAR.
胸主动脉腔内修复术（TEVAR）的进步为那些不适合开放手术的患者提供了一种治疗主动脉弓病变的替代方法。然而，TEVAR 的采用本身就存在固有并发症，特别是逆行性升主动脉夹层的发生，其发生率为 1-3%。为了最大限度地降低这些并发症的风险，必须注意几个关键的技术考虑因素。通过仔细和有条不紊的方法，完全切除原发入口撕裂是很重要的。近端和远端重建必须在血流动力学上是健全的，并注意稳定根部和远端主动脉。如果预计循环停止时间超过 30 分钟，应使用神经保护策略，如顺行脑灌注。本报告详细介绍了 TEVAR 后逆行性主动脉夹层修复的手术技术。
