Eugene J, Aronow W S, Stemmer E A
Clin Cardiol. 1981 Nov-Dec;4(6):356-9. doi: 10.1002/clc.4960040610.
Femoral artery perfusion for cardiopulmonary bypass is still employed for reoperation, procedures involving the thoracic aorta, and partial bypass in critical patients. Retrograde aortic dissection is the most significant complication of femoral perfusion. The reported incidence is from 0.6% to 14% with a mortality of 66%. Most of the deaths occurred in patients in whom the dissection was not recognized , or in whom the dissection was recognized but not treated appropriately. Our experience with retrograde dissection totals six patients of 640 (0.9%) in whom femoral inflow was used. Four of the six patients survived the dissection. Sudden increase in extracorporeal line pressure shortly after beginning cardiopulmonary bypass associated with decreased venous return, dampened radial arterial pressure, and the abrupt appearance of a bluish, bulging ascending aorta establishes the diagnosis. Survival is enhanced if cardiopulmonary bypass is promptly discontinued, aortic cannulation established, and bypass reinstituted with the induction of profound hypothermia. Circulatory arrest may then be employed to repair the false passage. In this series the proposed operation was completed in all six patients.
体外循环时股动脉灌注仍用于再次手术、涉及胸主动脉的手术以及病情危急患者的部分体外循环。逆行性主动脉夹层是股动脉灌注最严重的并发症。报道的发生率为0.6%至14%，死亡率为66%。大多数死亡发生在夹层未被识别的患者中，或夹层虽被识别但未得到适当治疗的患者中。我们在使用股动脉流入的640例患者中总共遇到6例逆行性夹层（0.9%）。6例患者中有4例在夹层后存活。体外循环开始后不久体外循环管路压力突然升高，同时伴有静脉回流减少、桡动脉压力衰减以及蓝色、膨隆的升主动脉突然出现，即可确立诊断。如果迅速停止体外循环、建立主动脉插管并在诱导深度低温的情况下重新开始体外循环，则可提高生存率。然后可采用循环停止来修复假腔。在本系列中，所有6例患者均完成了拟行的手术。
