Juraszek Andrzej, Berger Tim, Kreibich Maximilian, Tsagakis Konstantinos, Sioris Thanos, Berkarda Zeynep, Rylski Bartosz, Siepe Matthias, Czerny Martin
Department of Cardiovascular Surgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Cardio-thoracic Surgery, West German Heart and Vascular Center Essen, Essen, Germany.
Interdiscip Cardiovasc Thorac Surg. 2023 Dec 5;37(6). doi: 10.1093/icvts/ivad188.
The ideal treatment for aneuryms of aberrant left subclavian arteries with Kommerell's diverticulum arising from right aortic arches remains open.
Between January 2015 and December 2020, 5 patients with aneurysms from a right-sided aortic arch with aberrant left subclavian artery and Kommerell's diverticulum underwent repair by using the frozen elephant trunk technique in 3 aortic centres. Patients' characteristics were retrospectively reviewed and the surgical procedure and outcomes are presented.
The median age of the 2 male and 3 female patients was 59 (range from 49 to 63) years. The median operative times were as follows: surgery 405 min (range from 335 to 534), cardiopulmonary bypass time 244 min (range from 208 to 280) and aortic clamp time 120 min (from 71 to 184). The mean core temperature was 25.94°C (from 24 to 28). The intensive care unit stay was 4 days (range from 1 to 8) and the in-hospital stay 21 days (from 16 to 34). All patients were discharged and we observed no stroke or spinal cord ischaemia postoperatively. During the median follow-up time of 1003 days (range from 450 to 2306), 3 patients required subsequent thoracic endovascular distal stent graft extension.
The frozen elephant trunk technique is a good treatment option for patients with aneuryms of an aberrant left subclavian artery with Kommerell's diverticulum arising from right aortic arches. Secondary stent graft extension is a frequently needed component of the treatment concept.
对于源于右主动脉弓并伴有Kommerell憩室的迷走左锁骨下动脉动脉瘤，理想的治疗方法仍未明确。
在2015年1月至2020年12月期间，3个主动脉中心对5例源于右主动脉弓、伴有迷走左锁骨下动脉和Kommerell憩室的动脉瘤患者采用了“冰冻象鼻”技术进行修复。回顾性分析了患者的特征，并介绍了手术过程和结果。
2例男性和3例女性患者的中位年龄为59岁（范围49至63岁）。中位手术时间如下：手术405分钟（范围335至534分钟），体外循环时间244分钟（范围208至280分钟），主动脉阻断时间120分钟（范围71至184分钟）。平均核心体温为25.94°C（范围24至28°C）。重症监护病房停留时间为4天（范围1至8天），住院时间为21天（范围16至34天）。所有患者均已出院，术后未观察到中风或脊髓缺血。在中位随访时间1003天（范围450至2306天）内，3例患者需要随后进行胸段血管腔内远端支架移植物延伸术。
对于源于右主动脉弓并伴有Kommerell憩室的迷走左锁骨下动脉动脉瘤患者，“冰冻象鼻”技术是一种很好的治疗选择。二次支架移植物延伸术是该治疗理念中经常需要的组成部分。
