Department of Cardiovascular Surgery, Numata Neurosurgery Heart-Disease, 8 Sakae-cho, HospitalNumata, 378-0014, Japan.
Division of Health Administration, Hamakawasaki Operation Center, Toshiba Human Asset Service Corporation, Kawasaki, Japan.
J Cardiothorac Surg. 2024 Jun 18;19(1):334. doi: 10.1186/s13019-024-02841-5.
The surgical treatment strategy for aortic arch pathology with a shaggy aorta must be determined on a case-by-case basis because of the risk of catastrophic complications, such as brain infarction and spinal cord injury.
This report describes the surgical case of two saccular aneurysms of the arch and abdominal aorta associated with a shaggy aorta in a 63-year-old man who underwent total arch replacement and secondary thoracic endovascular aortic repair. Considering the risk of embolization during endovascular therapy, graft replacement for the abdominal aortic aneurysm was initially performed. On postoperative day 28, total arch replacement with the conventional elephant trunk was performed using the functional brain isolation technique, which involves manipulating places far from the atherosclerotic burden, such as arterial inflow for cardiopulmonary bypass and unclamping of neck vessels. On postoperative day 7 after total arch replacement, thoracic endovascular aortic repair was performed across the conventional elephant trunk in the nondiseased descending aorta. No postoperative complications, such as cerebrovascular failure, paraplegia, or embolization to abdominal viscera or lower extremities, occurred. The patient remained asymptomatic.
The present case suggests that total arch replacement with the conventional elephant trunk and secondary thoracic endovascular aortic repair may be an effective alternative for aortic arch pathology with a shaggy aorta. The strategy for surgical treatment in patients with aortic arch pathologies with a shaggy aorta must be judged on a case-by-case basis, considering patient characteristics, comorbidities, and preoperative evaluation using transesophageal echocardiography and computed tomography angiography, to eliminate potential determinants of intraoperative stroke.
由于存在灾难性并发症（如脑梗死和脊髓损伤）的风险，对于主动脉弓病变伴主动脉弓毛糙的患者，必须根据具体情况确定手术治疗策略。
本报告描述了一例 63 岁男性患者的手术病例，该患者患有弓部和腹主动脉的两个囊状动脉瘤，同时伴有主动脉弓毛糙，患者接受了全主动脉弓置换和二期胸主动脉腔内修复术。考虑到腔内治疗过程中发生栓塞的风险，首先进行了腹主动脉瘤的移植物置换。术后第 28 天，使用功能性脑隔离技术进行了全主动脉弓置换，该技术涉及到操作远离粥样硬化负荷的部位，如体外循环的动脉入路和颈部血管的夹闭。全主动脉弓置换术后第 7 天，在无病变的降主动脉内进行了传统象鼻术式的胸主动脉腔内修复术。患者无术后并发症，如脑血管衰竭、截瘫或向腹部内脏或下肢栓塞。患者无症状。
本病例提示，使用传统象鼻术式进行全主动脉弓置换和二期胸主动脉腔内修复术可能是一种治疗主动脉弓病变伴主动脉弓毛糙的有效替代方法。对于主动脉弓病变伴主动脉弓毛糙的患者，必须根据患者的特点、合并症以及经食管超声心动图和计算机断层血管造影术的术前评估来判断手术治疗策略，以消除术中卒中的潜在决定因素。
