Saito Yoshiaki, Kowatari Ryosuke, Minakawa Masahito, Daitoku Kazuyuki, Suzuki Yasuyuki, Fukuda Ikuo
Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Aomori, Japan.
J Vasc Surg Cases. 2015 Mar 16;1(1):32-35. doi: 10.1016/j.jvsc.2014.10.002. eCollection 2015 Mar.
Treatment for an extensively dissected aortic aneurysm is a surgical challenge. Open surgery using a left thoracotomy is promising but can be dangerous in patients with pulmonary comorbidity. We treated a 63-year-old man with chronic type B aortic dissection with aneurysmal change and ascending aortic dilation. The thoracoabdominal aorta was also dissected, dilated, and tapered; thus, a simple hybrid strategy was not possible, even with open fenestration. We performed ascending aortic replacement with reconstruction of the cervical vessels and extra-anatomic bypass from the ascending to descending aorta, with aneurysmal isolation. A stent graft was inserted at the true lumen of the residual aneurysm to reduce endopressure. Total thrombosis and reduction in size of the aneurysm was achieved, and the patient recovered well, without complications.
治疗广泛剥离的主动脉瘤是一项外科挑战。采用左胸切开术的开放手术有前景，但对于有肺部合并症的患者可能很危险。我们治疗了一名63岁患有慢性B型主动脉夹层并伴有动脉瘤样改变和升主动脉扩张的男性患者。胸腹主动脉也有剥离、扩张和变细；因此，即使采用开放开窗术，简单的杂交策略也不可行。我们进行了升主动脉置换术，重建了颈部血管，并从升主动脉到降主动脉进行了解剖外旁路移植，同时进行了动脉瘤隔离。在残余动脉瘤的真腔内插入了支架移植物以降低腔内压力。实现了动脉瘤的完全血栓形成和尺寸缩小，患者恢复良好，无并发症。
