Kazui T, Yamada O, Ito T, Kikuchi S, Komatsu S
Nihon Kyobu Geka Gakkai Zasshi. 1989 Jul;37(7):1436-40.
Four patients with expanding chronic dissecting thoracoabdominal aneurysm underwent total replacement of the thoracoabdominal aorta with reconstruction of all visceral branches, intercostal and lumbar arteries with the aid of femoro-femoral bypass. During aortic cross-clamping, selective celiac and both renal arteries perfusion was performed to prevent the organ ischemia. Somatosensory evoked potentials monitoring or spinal cord evoked potentials monitoring was also performed to detect the spinal cord ischemia. Surgical technique employed in this series was direct anastomosis of onlay patch graft to the normal true lumen from which visceral branches and intercostal and lumbar arteries arise. The celiac artery and left renal artery arise from the false lumen in some cases were reconstructed with graft interposition or direct anastomosis to an opening made in the onlay patch graft. All patients survived the operation, and are leading normal life late in the postoperative period except one who developed partial paraplegia. Total graft replacement of the thoracoabdominal aorta may be a valid technique for the treatment of expanding aneurysms of the dissecting thoracoabdominal aorta.
4例慢性扩张性胸腹主动脉夹层动脉瘤患者接受了胸腹主动脉全置换术，术中借助股-股旁路对所有内脏分支、肋间动脉和腰动脉进行重建。在主动脉阻断期间，进行选择性腹腔干和双侧肾动脉灌注以预防器官缺血。还进行体感诱发电位监测或脊髓诱发电位监测以检测脊髓缺血。本系列采用的手术技术是将补片移植片直接吻合到发出内脏分支、肋间动脉和腰动脉的正常真腔。腹腔干动脉和部分病例中发自假腔的左肾动脉，采用移植血管植入或直接吻合到补片移植片上的开口处进行重建。所有患者均存活，除1例发生部分截瘫外，其余患者术后生活正常。胸腹主动脉全移植术可能是治疗扩张性胸腹主动脉夹层动脉瘤的有效技术。
