Renard Régis, Coscas Raphaël, Sylvestre Raphaëlle, Javerliat Isabelle, Goëau-Brissonnière Olivier, Coggia Marc
Department of Vascular Surgery, Ambroise Paré University Hospital, Boulogne-Billancourt, France.
UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, Villejuif, France.
J Vasc Surg Cases Innov Tech. 2020 Sep 8;7(1):137-141. doi: 10.1016/j.jvscit.2020.08.028. eCollection 2021 Mar.
In various circumstances of aortic repairs (heavy circumferential calcifications or shaggy aorta with extensive thrombus), open and endovascular techniques are at high risk. In addition to a likelihood of emboli, aortic clamping can be complicated by rupture and endovascular techniques may not be successful. We here describe a simple and reproducible hybrid technique that allows performing an aortic anastomosis without clamping in these situations.
After a limited exposure of the anterior aortic wall in a healthy segment, a prosthetic graft is sutured without any arteriotomy or clamping (adventitial suture), mimicking the final aspect of an end-to-side anastomosis. The graft and the anastomosis site are punctured using a long needle, allowing a guidewire to be positioned in the aorta under fluoroscopic guidance. Protected covered stenting of the anastomosis site opens the anastomosis without aortic clamping. After tunneling the graft to the target artery, the distal anastomosis is performed in a usual fashion.
This technique was successfully used in 10 challenging consecutive cases with a sustained patency.
This hybrid clampless technique for aortic anastomosis represents a useful alternative for challenging lesions unsuitable for a simple open or endovascular treatment.
在各种主动脉修复情况下（严重的环形钙化或伴有广泛血栓的粗糙主动脉），开放手术和血管腔内技术都具有高风险。除了有栓子形成的可能性外，主动脉钳夹可能会并发破裂，而血管腔内技术可能并不成功。我们在此描述一种简单且可重复的杂交技术，该技术能够在这些情况下不进行钳夹就完成主动脉吻合。
在健康节段有限暴露主动脉前壁后，不进行任何动脉切开或钳夹（外膜缝合）就缝合人工血管，模拟端侧吻合的最终形态。用长针穿刺人工血管和吻合部位，在荧光透视引导下将导丝置于主动脉内。对吻合部位进行带膜支架保护，在不钳夹主动脉的情况下开放吻合口。将人工血管引入目标动脉后，以常规方式进行远端吻合。
该技术在连续10例具有挑战性的病例中成功应用，血管保持通畅。
这种用于主动脉吻合的杂交无钳夹技术是一种有用的替代方法，适用于不适合单纯开放手术或血管腔内治疗的具有挑战性的病变。
