Henmi Soichiro, Ikeno Yuki, Yokawa Koki, Gotake Yasuko, Nakai Hidekazu, Yamanaka Katsuhiro, Inoue Takeshi, Tanaka Hiroshi, Okita Yutaka
Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Eur J Cardiothorac Surg. 2019 Feb 12. doi: 10.1093/ejcts/ezz015.
This study aimed to analyse the early patency rate and long-term outcomes of reattached segmental intercostal arteries using graft interposition, single-cuff anastomosis or island reconstruction.
We selected 172 consecutive patients who underwent open surgery for the thoracoabdominal aorta with reattachment of segmental arteries between October 1999 and March 2018. The early patency of segmental arteries was analysed using enhanced computed tomography. Segmental arteries were reconstructed using graft interposition (n = 111), single-cuff anastomosis (n = 38) or island reconstruction (n = 23).
The hospital mortality was 6.4%. Twenty patients developed spinal cord ischaemic injury (permanent, n = 12 or transient, n = 8). Spinal cord injury was found in 16, 3 and 1 patients in the graft interposition, single-cuff anastomosis and island reconstruction groups, respectively. Overall, 475 segmental arteries were reattached (mean number per patient 2.8 ± 1.3). The overall early patency rate was 63.4%. The patency rates in island reconstruction (91.2%) and single-cuff anastomosis (77.1%) were significantly better than that in graft interposition (54.0%; P < 0.01). However, 6 patients with island reconstruction of segmental arteries had an aneurysm formation at the intercostal artery reconstruction site, of whom 4 patients underwent reoperation during follow-up. None of the patients with graft interposition or single-cuff reattachment had a patch aneurysm in segmental arteries.
Island reconstruction and single-cuff anastomosis might offer better patency rates and prevent spinal cord ischaemic injury than graft interposition. Because some patients with island reconstruction required reoperation for patch aneurysms in segmental arteries, single-cuff anastomosis is preferable in terms of early- and long-term outcomes.
本研究旨在分析采用移植血管搭桥、单袖口吻合或岛状重建术重新连接节段性肋间动脉后的早期通畅率和长期预后。
我们选取了1999年10月至2018年3月期间连续172例行胸腹主动脉开放手术并重新连接节段性动脉的患者。采用增强计算机断层扫描分析节段性动脉的早期通畅情况。节段性动脉重建采用移植血管搭桥术（n = 111）、单袖口吻合术（n = 38）或岛状重建术（n = 23）。
医院死亡率为6.4%。20例患者发生脊髓缺血性损伤（永久性损伤，n = 12例；短暂性损伤，n = 8例）。移植血管搭桥组、单袖口吻合组和岛状重建组分别有16例、3例和1例患者发生脊髓损伤。总体而言，共重新连接了475条节段性动脉（平均每位患者2.8 ± 1.3条）。总体早期通畅率为63.4%。岛状重建术（91.2%）和单袖口吻合术（77.1%）的通畅率明显优于移植血管搭桥术（54.0%；P < 0.01）。然而，6例采用岛状重建术重建节段性动脉的患者在肋间动脉重建部位出现动脉瘤形成，其中4例患者在随访期间接受了再次手术。移植血管搭桥或单袖口重新连接的患者中，节段性动脉均未出现补片动脉瘤。
与移植血管搭桥术相比，岛状重建术和单袖口吻合术可能具有更好的通畅率，并可预防脊髓缺血性损伤。由于一些采用岛状重建术的患者因节段性动脉补片动脉瘤需要再次手术，就早期和长期预后而言，单袖口吻合术更可取。
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