Ku Min Jung, Lee Yu Ri, Kim Joon Bum
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
JTCVS Tech. 2024 Jan 19;24:14-19. doi: 10.1016/j.xjtc.2024.01.006. eCollection 2024 Apr.
Mid-aortic syndrome is a rare condition characterized by severe aortic narrowing, leading to high upper body blood pressure and organ hypoperfusion, necessitating surgical intervention. Although central bypassing is considered ideal, it involves extensive incisions. To overcome these limitations, less-invasive approaches have been developed. This study aims to introduce a mini-access approach using video-endoscopy and to evaluate the feasibility and outcomes of mini-access ascending aorto-bifemoral bypass surgery.
From November 2020 to May 2022, we performed ascending aorta to bifemoral artery bypass operations on 7 patients to treat steno-occlusive diseases in the downstream aorta. A Y-graft was created, and procedures were conducted under general anesthesia using video-endoscopy with limited skin incisions.
Intraoperatively, there were no major complications, and none of the patients required cardiopulmonary bypass support. Furthermore, there were no postoperative mortalities or major complications. Postoperatively, the mean ankle-brachial index significantly improved from 0.59/0.59 to 0.96/0.92 ( = .004), and the mean glomerular filtration rate increased from 61.1 to 85.3 mL/min/1.73 mm ( = .012). Additionally, symptoms of claudication resolved in all patients.
Videoscope-assisted mini-access aortic bypass surgery not only provides favorable early postoperative outcomes but also represents a technically feasible alternative to traditional surgical approaches for the treatment of steno-occlusive aortic diseases.
中段主动脉综合征是一种罕见疾病，其特征为严重的主动脉狭窄，导致上身高血压和器官灌注不足，需要进行手术干预。尽管中心旁路术被认为是理想的，但它需要广泛的切口。为克服这些局限性，已开发出侵入性较小的方法。本研究旨在介绍一种使用视频内镜的微创入路，并评估微创升主动脉-双股动脉旁路手术的可行性和疗效。
2020年11月至2022年5月，我们对7例患者进行了升主动脉至双股动脉旁路手术，以治疗降主动脉的狭窄闭塞性疾病。制作了一个Y型移植物，并在全身麻醉下使用视频内镜进行手术，皮肤切口有限。
术中无重大并发症，所有患者均无需体外循环支持。此外，术后无死亡病例或重大并发症。术后，平均踝臂指数从0.59/0.59显著提高至0.96/0.92（P = 0.004），平均肾小球滤过率从61.1增加至85.3 mL/min/1.73 m²（P = 0.012）。此外，所有患者的间歇性跛行症状均得到缓解。
视频内镜辅助的微创主动脉旁路手术不仅能提供良好的早期术后疗效，而且是治疗主动脉狭窄闭塞性疾病的传统手术方法在技术上可行的替代方案。
