Selective left subclavian ligation in total aortic arch replacement.
Selective left subclavian ligation in total aortic arch replacement.
复制标题
全主动脉弓置换术中选择性左锁骨下结扎术。
DOI：
10.1016/j.athoracsur.2011.08.032
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Zhiyun Xu
中科院分区：
文献类型：
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作者：
Yong Cui;F. Lu;Lin Han;Ji;Zhi;Zhiyun Xu
在全主动脉弓置换术中，如果左锁骨下动脉（LSA）被升主动脉或右半主动脉弓中的巨大假腔移位，则通常难以操作。方法回顾性分析2008年1月至2010年6月29例斯坦福大学A型主动脉夹层患者行全弓置换术和支架“象鼻”植入术的临床资料。由于暴露困难，结扎了LSA（21例男性，8例女性，年龄19 - 55岁）。通过术前影像学和术中观察，全面评估Willis环和双侧椎动脉的侧支循环。如果侧支循环充足，则结扎LSA;如果侧支循环不足，则从升主动脉到左腋动脉建立额外的旁路移植物。术后左臂血压低于右臂（78 ± 17.3 vs 126 ± 3.7 mm Hg，p < 0.01），但血氧饱和度、皮肤温度和左手力量正常。随访6 ~ 36个月（16.6 ± 9.0）个月，无一例出现LSA盗血综合征或上肢缺血症状。结论A型夹层患者在侧支循环暴露不足的情况下，在严格评估侧支循环情况后行LSA结扎术是安全的，并可明显简化手术。
BACKGROUNDThe left subclavian artery (LSA) is usually difficult to manipulate in total aortic arch replacement procedures if it is displaced by huge false lumens in the ascending aorta or right hemiarch. We summarize our experience of selectively ligating the deeply located LSA in total aortic arch replacement and stented “elephant trunk” implantation procedures for Stanford type A aortic dissection.METHODSData of 29 patients with deep LSA undergoing total arch replacement and stented “elephant trunk” implantation from January 2008 to June 2010 were reviewed. The LSA was ligated because of the difficult exposure (21 males, 8 females, age 19 to 55). Collateral circulation of the circle of Willis and bilateral vertebral arteries were assessed thoroughly by preoperative imaging and intraoperative observations. If collateral circulation was sufficient, LSA was ligated; if insufficient, an additional bypass graft was created from the ascending aorta to the left axillary artery.RESULTSTwenty-eight patients survived the operation with 1 early death. Postoperative blood pressures were lower in the left arm than in the right (78 ± 17.3 vs 126 ± 3.7 mm Hg, p < 0.01), but oxygen saturation, skin temperature, and strength of the left hand were normal. The surviving patients have been followed for 16.6 ± 9.0 months (6 to 36) and none had symptoms of LSA steal syndrome or arm ischemia.CONCLUSIONSLigation of the LSA after strict evaluation of collateral circulation could be safe for type A dissection patients if the exposure is insufficient, and this method can simplify the operation significantly.