Fukuda I, Ohuchi H, Matsuzaki K
Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Ibaraki, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Apr;43(4):502-5.
A postoperative pseudoaneurysm of the ascending aorta is reported. The patient was a 73-year-old female with a history of graft replacement of the ascending aorta for acute type A dissection 5 years ago. She was referred to our hospital because of chest pain. Preoperative radiographic examination revealed a large pseudoaneurysm of the ascending aorta close to the distal anastomotic site of the graft as well as an aneurysm of transverse arch. During surgery, the pseudoaneurysm originated from a intimal defect in the aortic wall 1 cm distal to the suture line. It is suggested that the pseudoaneurysm was caused by a clamp injury during the initial operation. Replacement of the ascending aorta and transverse arch was successfully performed under selective cerebral perfusion. We should keep the clamp injury in mind when we apply an aortic clamp to a fragile dissected aorta.
本文报道了一例升主动脉术后假性动脉瘤。患者为73岁女性，5年前因急性A型主动脉夹层行升主动脉人工血管置换术。因胸痛就诊于我院。术前影像学检查显示升主动脉近端人工血管吻合口附近有一巨大假性动脉瘤，同时合并主动脉弓动脉瘤。手术中发现假性动脉瘤起源于缝线远端1 cm处主动脉壁的内膜缺损。推测假性动脉瘤是由初次手术时的钳夹损伤所致。在选择性脑灌注下成功进行了升主动脉和主动脉弓置换术。当对脆弱的夹层主动脉应用主动脉钳夹时，应牢记钳夹损伤这一因素。
