Tanaka H, Yanagiya A, Kazui T
Department of Cardiovascular Surgery, Nikko Memorial Hospital, Muroran, Japan.
Nihon Geka Gakkai Zasshi. 1997 May;98(5):524-8.
A 52-year-old man with dissecting thoracoabdominal aortic aneurysm (impending rupture) involving the celiac, superior mesenteric and renal arteries underwent graft replacement of the thoracoabdominal aorta with reconstruction of all visceral branches and intercostal arteries (Th11,12) with the aid of femoro-femoral bypass. The bypass was performed using a heparin coated percutaneous cardiopulmonary support system with low doses of heparin, maintaining activated coagulation time at about 300 seconds. During the reconstruction of the major visceral branches, the branches were separately cannulated from inside the aorta, and perfused selectively via partial extracorporeal circulation. The intercostal arteries were reconstructed segmentally to minimize the duration of ischemia. During the repair of the intercostal arteries, Fogarty balloon catheters were inserted into the intercostal arteries to prevent back bleeding and ischemia. The patient had a satisfactory postoperative course.
一名52岁男性，患有累及腹腔干、肠系膜上动脉和肾动脉的胸主动脉夹层动脉瘤（濒临破裂），在股-股旁路辅助下接受了胸腹主动脉移植术，并重建了所有内脏分支和肋间动脉（第11、12胸椎水平）。旁路手术使用了低剂量肝素涂层的经皮心肺支持系统，将活化凝血时间维持在约300秒。在重建主要内脏分支时，从主动脉内部对分支进行分别插管，并通过部分体外循环进行选择性灌注。肋间动脉进行分段重建，以尽量缩短缺血时间。在修复肋间动脉时，将Fogarty球囊导管插入肋间动脉以防止回血和缺血。患者术后恢复过程顺利。
