Seguchi Ryuta, Kiuchi Ryuta, Horikawa Takafumi, Tarui Tatsuya, Sanada Junichiro, Ohtake Hiroshi, Watanabe Go
Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan.
Department of Vascular Surgery, Ageo Central General Hospital, Ageo, Saitama, Japan.
Ann Vasc Dis. 2021 Jun 25;14(2):153-158. doi: 10.3400/avd.oa.21-00025.
Zone 0 thoracic endovascular aortic repair (TEVAR) is associated with a high incidence of cerebral infarction mostly due to the embolic shower of a plaque from the aortic arch when the stent graft brushes against the aortic wall. Thus, it is important to develop a method for protecting the brain from such embolism. We report the outcomes of Zone 0 TEVAR with a novel brain protection method using selective cerebral perfusion under extracorporeal membrane oxygenation (ECMO). Two T-shaped grafts with ringed expanded polytetrafluoroethylene (ePTFE) were created using an 8-mm-ringed ePTFE anastomosed end-to-side with a 7-mm-ringed ePTFE. Carotid-carotid bypass and axillo-axillary bypass were established using these grafts. ECMO was connected to the grafts and the femoral vein. Bilateral carotid and axillary arteries were blocked, and cerebral perfusion was selectively maintained using ECMO. Total endovascular Zone 0 TEVAR was performed. The patency of brachiocephalic artery was maintained using the chimney or in situ fenestration technique. Since August 2016, seven patients with aortic arch aneurysms underwent the procedure. The mortality rate was 0%. No neurological complications developed. This brain protection method using selective cerebral perfusion under ECMO is a safe method for Zone 0 TEVAR.
0区胸主动脉腔内修复术（TEVAR）与脑梗死的高发生率相关，这主要是由于当覆膜支架接触主动脉壁时，主动脉弓上的斑块形成栓子脱落所致。因此，开发一种保护大脑免受此类栓塞的方法很重要。我们报告了采用体外膜肺氧合（ECMO）下选择性脑灌注这种新型脑保护方法进行0区TEVAR的结果。使用8毫米带环膨体聚四氟乙烯（ePTFE）与7毫米带环ePTFE端侧吻合，制作了两个带环ePTFE的T形移植物。使用这些移植物建立颈-颈旁路和腋-腋旁路。将ECMO连接到移植物和股静脉。双侧颈动脉和腋动脉被阻断，使用ECMO选择性地维持脑灌注。进行了全腔内0区TEVAR。使用烟囱技术或原位开窗技术维持头臂动脉的通畅。自2016年8月以来，7例主动脉弓动脉瘤患者接受了该手术。死亡率为0%。未发生神经并发症。这种在ECMO下采用选择性脑灌注的脑保护方法对于0区TEVAR是一种安全的方法。
