Hioki Iwao, Urata Yasuhisa, Sato Tomoaki, Yuasa Uhito
Division of Cardiovascular Surgery, Mie Chuo Medical Center, Tsu, Japan.
Kyobu Geka. 2022 Mar;75(3):193-197.
Treating a thoracic aortic aneurysm (TAA) after coronary artery bypass (CABG) surgery requires an appropriate surgical procedure to preserve the bypass grafts. We present a case of open stent grafting. The patient was a 71-year-old man with a history of CABG. Chest computed tomography (CT) revealed a saccular-shaped aortic aneurysm in the aortic arch with diameter of 56 mm. Coronary angiography revealed the LIMA and SVG grafts were patent. The chest was opened via re-midsternotomy. After a circulatory arrest was induced at 30 ℃ with cerebral perfusion, the anterior surface of the arch was incised in a hemi-circumferencial mannar between the left common carotid and left subclavian arteries. The stent graft was inserted into the aortic arch and was deployed. The proximal side of the graft was then trimmed, and the posterior aortic wall and the graft were continuously anastomosed, the aortic incision was continuously closed involving anterior side of the graft. Finally, the left axillary artery was reconstructed. The patient's postoperative course was uneventful and he was discharged on postoperative day 10. A open stent grafting via an aortotomy was useful in the surgery for TAA after CABG.
冠状动脉旁路移植术（CABG）后治疗胸主动脉瘤（TAA）需要采取适当的手术方法来保护旁路移植物。我们报告一例开放支架植入术病例。患者为一名71岁男性，有CABG病史。胸部计算机断层扫描（CT）显示主动脉弓部有一个囊状主动脉瘤，直径56mm。冠状动脉造影显示左内乳动脉（LIMA）和大隐静脉（SVG）移植物通畅。经重新正中胸骨切开术打开胸腔。在30℃诱导循环停止并进行脑灌注后，在左颈总动脉和左锁骨下动脉之间以半圆周方式切开主动脉弓前表面。将支架移植物插入主动脉弓并展开。然后修剪移植物近端，将主动脉后壁与移植物连续吻合，主动脉切口连续缝合，包括移植物前侧。最后重建左腋动脉。患者术后恢复顺利，术后第10天出院。经主动脉切开术进行开放支架植入术在CABG后TAA手术中是有用的。
