Hachiro Y, Kikuchi Y, Sakurada T, Shiiku C, Kagaya H
Department of Cardiovascular Surgery, National Obihiro Hospital, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Dec;44(12):2172-6.
A 65-year-old male underwent graft patch aortoplasty for a sacciform aneurysm of the distal aortic arch. Three years later an aneurysm developed around the site of the graft patch aortoplasty, therefore total arch graft replacement was required. The operation was performed through median sternotomy and left supraclavicular incision. The ascending aorta was selected for the aortic perfusion site, avoiding thromboembolism. Selective cerebral perfusion (SCP) was employed to protect the brain. Open distal anastomosis with circulatory arrest offered the optimal operating field despite re-operation. Graft replacement or graft patch aortoplasty has been proposed for the treatment of sacciform aneurysm. However, there is a possibility of aneurysmal change around the site of resected aneurysm. Furthermore because of the development of surgical skill and extracorporeal circulation technique, total arch graft replacement should be considered for the surgical treatment of distal aortic arch aneurysm.
一名65岁男性因主动脉弓远端囊状动脉瘤接受了移植补片主动脉成形术。三年后，在移植补片主动脉成形术部位周围出现了动脉瘤，因此需要进行全弓移植置换术。手术通过正中胸骨切开术和左锁骨上切口进行。选择升主动脉作为主动脉灌注部位，以避免血栓栓塞。采用选择性脑灌注（SCP）来保护大脑。尽管是再次手术，但在循环停止下进行开放远端吻合提供了最佳的手术视野。对于囊状动脉瘤的治疗，有人提出进行移植置换或移植补片主动脉成形术。然而，在切除的动脉瘤部位周围存在动脉瘤样改变的可能性。此外，由于手术技术和体外循环技术的发展，对于主动脉弓远端动脉瘤的手术治疗应考虑进行全弓移植置换术。
