Niinimaki Eetu, Kajander Henri, Paavonen Timo, Sioris Thanos, Mennander Ari
Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere University, Tampere, Finland.
Heart Center, Cardiac Research, Tampere University Hospital, Tampere University, Tampere, Finland.
Int J Angiol. 2014 Jun;23(2):101-6. doi: 10.1055/s-0034-1370887.
Definitive treatment of extended thoracic aortic dilatation is a major surgical challenge. Histopathology of resected thoracic aortic wall may reveal undiagnosed aortitis affecting outcome. We sought to investigate the benefit of thorough histopathology after one-stage corrective surgery for the treatment of extended thoracic aortic dilatation. Five patients underwent one-stage corrective surgery using the hybrid open arch repair by the frozen elephant trunk together with endovascular aortic grafting. A representative sample of the resected aortic arch was procured for histology. T- and B-lymphocytes, plasma cells, macrophages, and immunoglobulin G4 (IgG4) positivity were evaluated by immunohistochemistry. The mean preoperative maximum aortic diameter was 54 mm (range, 41-79 mm). The mean follow-up was 18 months (range, 1-24 months). As confirmed by computed tomography (CT) upon follow-up, complete thrombosis of the false lumen at the level of the frozen elephant trunk was achieved in all patients with dissection. One patient was operated due to atherosclerotic dilatation of the thoracic aorta, and postoperative CT showed successful exclusion of the atherosclerotic dilatation; this 75-year-old man was diagnosed with IgG4-positive aortitis and experienced unexpected blindness after surgery without evidence of emboli or long-term neurological impairment upon repeated brain CT. The hybrid open arch repair by the frozen elephant trunk and simultaneous endovascular repair is a feasible choice for one-stage surgery through sternotomy aiming at definitive treatment of extended thoracic aortic pathology. However, systematic evaluation of inflammation may reveal concealed aortitis affecting postoperative outcome and need for long-term surveillance.
广泛性胸主动脉扩张的确定性治疗是一项重大的外科挑战。切除的胸主动脉壁的组织病理学检查可能会揭示未被诊断出的主动脉炎，从而影响治疗结果。我们旨在研究一期矫正手术后进行全面组织病理学检查对治疗广泛性胸主动脉扩张的益处。5例患者接受了一期矫正手术，采用冷冻象鼻技术联合血管腔内主动脉 grafting进行杂交开放式主动脉弓修复。获取切除的主动脉弓的代表性样本进行组织学检查。通过免疫组织化学评估T淋巴细胞、B淋巴细胞、浆细胞、巨噬细胞和免疫球蛋白G4（IgG4）的阳性情况。术前主动脉最大直径的平均值为54毫米（范围为41-79毫米）。平均随访时间为18个月（范围为1-24个月）。随访时通过计算机断层扫描（CT）证实，所有夹层患者在冷冻象鼻水平的假腔均完全血栓形成。1例患者因胸主动脉粥样硬化扩张接受手术，术后CT显示成功排除了粥样硬化扩张；这位75岁的男性被诊断为IgG4阳性主动脉炎，术后出现意外失明，反复脑部CT检查未发现栓子或长期神经功能损害的证据。冷冻象鼻联合同期血管腔内修复的杂交开放式主动脉弓修复术是通过胸骨切开术进行一期手术治疗广泛性胸主动脉病变的可行选择。然而，对炎症的系统评估可能会揭示影响术后结果的隐匿性主动脉炎，并需要长期监测。
