Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
Interact Cardiovasc Thorac Surg. 2022 Jul 9;35(2). doi: 10.1093/icvts/ivac185.
The adventitial inversion technique is used widely for aortic reconstruction for acute type A aortic dissection, as it easily controls the bleeding at anastomotic sites and closes the patent false lumen. However, this technique for arch vessel reconstruction has not been previously reported. Therefore, we applied the adventitial inversion technique for dissected arch vessel reconstruction to close the patent false lumen.
Among 57 consecutive patients who underwent emergency surgical treatment for acute type A aortic dissection from July 2006 to July 2012, the adventitial inversion technique for the dissected arch vessels was performed in 26 patients (42 arch vessel stumps). The patency and morphologic change of the false lumen of the arch vessels were evaluated using contrast-enhanced computed tomography.
Overall, 2 hospital deaths were recorded, and the hospital mortality rate was 4%. No postoperative cerebral strokes and reoperations due to bleeding occurred. Follow-up by contrast-enhanced computed tomography was completed in 24 patients (37 stumps) with a mean duration of 99 ± 35 months. The postoperative closure rate of the false lumen after adventitial inversion was 86%, which was higher than when adventitial inversion was not used. No adverse events including stroke occurred during follow-up period.
This technique facilitates the closure of the false lumen of dissected arch vessels and might improve clinical outcomes.
外膜翻转技术广泛应用于急性 A 型主动脉夹层的主动脉重建，因为它可以轻松控制吻合部位的出血并封闭通畅的假腔。然而，这种技术用于弓部血管重建尚未有报道。因此，我们应用外膜翻转技术来封闭夹层弓部血管的假腔。
2006 年 7 月至 2012 年 7 月，57 例急性 A 型主动脉夹层患者接受了紧急外科治疗，其中 26 例（42 个弓部血管残端）采用外膜翻转技术进行了弓部血管重建。使用增强 CT 评估了弓部血管假腔的通畅性和形态变化。
总体上，2 例患者术后死亡，住院死亡率为 4%。无术后脑出血和因出血再次手术的病例。24 例（37 个残端）患者完成了术后增强 CT 随访，平均随访时间为 99±35 个月。外膜翻转术后假腔的闭合率为 86%，高于未使用外膜翻转术时的假腔闭合率。随访期间无卒中或其他不良事件发生。
该技术有利于封闭夹层弓部血管的假腔，可能改善临床预后。
