Kato M, Ohnishi K, Kaneko M, Ueda T, Kishi D, Mizushima T, Matsuda H
Division of Cardiovascular Surgery, Osaka Prefectural Hospital, Japan.
Circulation. 1996 Nov 1;94(9 Suppl):II188-93.
To alleviate the invasiveness of surgical treatment for thoracic aortic aneurysm or dissection involving the distal arch, we developed a new method of implanting a graft in the distal anastomotic portion that does not require dissection, suture, or lateral thoracotomy.
The tight circumferential attachment between the graft and the aortic inner wall, produced by the hoop strength of a self-expanding (Gianturco) stent that is anchored into the woven polyester graft, takes the place of the conventional anastomotic suture at the distal end of the graft. This new surgical method requires only a median sternotomy and relatively short circulatory arrest time to repair a thoracic aneurysm or dissection involving the distal arch. In a 12-month period in 1994 and 1995, we applied this new method in 10 cases (seven true aneurysms and three dissections). Complete thrombosis of the aneurysms or false lumens surrounding the grafts resulted in all 10. There were no surgical deaths, and the major complications were two cerebral infarctions due to inappropriate protection of the brain and dissecting procedure of an aortic arch, respectively.
These preliminary results indicate that this new graft-implanting method with the stented graft should be considered one of the less-invasive surgical treatments for thoracic aneurysm and dissection involving the distal arch.
为减轻涉及主动脉弓远端的胸主动脉瘤或夹层手术治疗的侵入性，我们开发了一种在远端吻合部位植入移植物的新方法，该方法无需解剖、缝合或开胸手术。
由锚定在编织聚酯移植物中的自膨式（Gianturco）支架的环向强度产生的移植物与主动脉内壁之间紧密的圆周附着，取代了移植物远端的传统吻合缝合。这种新的手术方法仅需正中胸骨切开术和相对较短的循环阻断时间即可修复涉及主动脉弓远端的胸主动脉瘤或夹层。在1994年和1995年的12个月期间，我们将这种新方法应用于10例患者（7例真性动脉瘤和3例夹层）。所有10例患者的动脉瘤或移植物周围的假腔均完全血栓形成。无手术死亡病例，主要并发症分别为因脑保护不当和主动脉弓解剖操作导致的2例脑梗死。
这些初步结果表明，这种带支架移植物的新移植物植入方法应被视为治疗涉及主动脉弓远端的胸主动脉瘤和夹层的微创外科治疗方法之一。
