Sugiyama Kayo, Watanuki Hirotaka, Tochii Masato, Futamura Yasuhiro, Ishizuka Koki, Matsuyama Katsuhiko
Department of Cardiac Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan.
Ann Vasc Dis. 2022 Dec 25;15(4):295-300. doi: 10.3400/avd.oa.21-00128.
Total aortic arch replacement (TAR), particularly in individuals with extensive atherosclerotic alterations, especially shaggy aortas, is more crucial and difficult. The objective of this retrospective investigation was to ascertain if patients with shaggy aortas would respond to modified isolated cerebral perfusion (ICP). Between 2015 and 2020, nine individuals with shaggy aortas who received treatment for arch aneurysms were examined. Four and five patients, respectively, who had arch replacement with traditional selective cerebral perfusion (SCP) and modified ICP, were evaluated, and their short- and long-term results were compared. There were no appreciable variations in the postoperative results between patients with traditional SCP and those with modified ICP. Following surgery, one patient developed paraparesis, while two individuals with traditional SCP experienced persistent neurological damage. In patients with modified ICP, there were no postoperative neurological or other problems associated to atherosclerosis; nevertheless, one patient experienced stroke 5 months after surgery. Patients with shaggy aorta may not receive enough brain protection from TAR with standard SCP because single axillary artery perfusion can result in nonphysiological flow and atheroma separation. Even in patients with shaggy aortas, TAR with modified ICP is safe, but late-phase severe adverse cerebrovascular events should be taken into account.
全主动脉弓置换术（TAR），尤其是在患有广泛动脉粥样硬化改变的个体中，特别是主动脉表面粗糙的患者中，更为关键且困难。这项回顾性研究的目的是确定主动脉表面粗糙的患者对改良的选择性脑灌注（ICP）是否有反应。在2015年至2020年期间，对9名接受主动脉弓动脉瘤治疗的主动脉表面粗糙的患者进行了检查。分别对4例接受传统选择性脑灌注（SCP）进行弓部置换的患者和5例接受改良ICP的患者进行了评估，并比较了他们的短期和长期结果。接受传统SCP的患者和接受改良ICP的患者术后结果没有明显差异。术后，1例患者出现双下肢轻瘫，而2例接受传统SCP的患者出现持续性神经损伤。在接受改良ICP的患者中，术后没有出现与动脉粥样硬化相关的神经或其他问题；然而，1例患者在术后5个月发生了中风。由于单腋动脉灌注可能导致非生理性血流和动脉粥样斑块分离，主动脉表面粗糙的患者可能无法从标准SCP的TAR中获得足够的脑保护。即使在主动脉表面粗糙的患者中，改良ICP的TAR也是安全的，但应考虑晚期严重的脑血管不良事件。
