Debus E Sebastian, Kölbel Tilo, Wipper Sabine, Diener Holger, Reiter Beate, Detter Christian, Tsilimparis Nikolaos
1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany.
2 German Aortic Center Hamburg, Department of Cardiothoracic Surgery, University Heart Center, Hamburg, Germany.
J Endovasc Ther. 2017 Apr;24(2):277-280. doi: 10.1177/1526602816678992. Epub 2016 Nov 15.
To describe a hybrid technique of reversed frozen elephant trunk to treat thoracoabdominal aortic aneurysms (TAAA) through an abdominal only approach.
The technique is demonstrated in a 29-year-old Marfan patient with a chronic type B aortic dissection previously treated with a thoracic stent-graft who presented with a thoracoabdominal false lumen aneurysm. Through an open distal retroperitoneal approach to the abdominal aorta, a frozen elephant trunk graft was implanted over a super-stiff wire upside down with the stent-graft component in the thoracic aorta. Following deployment of the stent-graft proximally and preservation of renovisceral perfusion in a retrograde manner, the renovisceral vessels were sequentially anastomosed to the elephant trunk graft branches, thus reducing the ischemia time of the end organs. The aortic sac was then opened, and the distal part of the hybrid graft was anastomosed with a further bifurcated graft to the iliac vessels.
The reversed frozen elephant trunk technique is feasible for hybrid treatment of TAAAs via an abdominal approach only. This has the benefit of substantially reducing the trauma of thoracic exposure, thus preserving major benefits of open thoracoabdominal surgery, such as the presence of short bypasses to the renovisceral vessels and reimplantation of lumbar arteries to reduce spinal cord ischemia.
描述一种经单纯腹部入路的反向冻结象鼻技术，用于治疗胸腹主动脉瘤（TAAA）。
该技术在一名29岁的马凡综合征患者中得到展示，该患者曾接受胸段支架型人工血管治疗慢性B型主动脉夹层，现出现胸腹假性腔动脉瘤。通过开放的远端腹膜后入路至腹主动脉，将冻结象鼻移植物倒置在超硬导丝上植入，支架型人工血管部分位于胸主动脉。在近端部署支架型人工血管并逆行保留肾血管灌注后，将肾血管依次吻合至象鼻移植物分支，从而缩短终末器官的缺血时间。然后打开主动脉瘤囊，将杂交移植物的远端与另一分叉移植物吻合至髂血管。
反向冻结象鼻技术经单纯腹部入路用于TAAA的杂交治疗是可行的。这具有显著减少胸部暴露创伤的优点，从而保留了开放胸腹手术的主要益处，如存在至肾血管的短旁路以及重新植入腰动脉以减少脊髓缺血。
