Surgical repair of aneurysms involving the distal aortic arch.
Surgical repair of aneurysms involving the distal aortic arch.
复制标题
涉及远端主动脉弓的动脉瘤的手术修复。
DOI：
10.1016/s0022-5223(19)36055-6
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发表时间：
1986
期刊：
影响因子：
--
通讯作者：
J. Duncan
中科院分区：
文献类型：
--
作者：
G. Kay;D. Cooley;J. Livesay;M. Reardon;J. Duncan
涉及横主动脉弓的动脉瘤的手术方法通常需要灌注或低温停循环技术。当主动脉弓远端开始出现动脉瘤而未累及无名动脉时，可采用简化的手术入路。从1975年11月至1984年1月，32例患者（22例男性，10例女性;平均年龄61岁）通过简单的交叉夹闭患病的主动脉段进行了主动脉弓远端动脉瘤修复术。在每例患者中，动脉瘤起源于无名动脉远端，并累及左锁骨下动脉或左颈总动脉起点处的主动脉弓。近端控制通过交叉夹闭无名动脉和左颈动脉之间的主动脉弓实现。未使用分流器或体外旁路。近端高血压通过硝普钠输注控制。所有患者均接受肝素化。28例患者的Dacron移植物置换和3例患者的Dacron补片修复需要平均27 ± 10分钟的主动脉阻断时间。32例患者手术修复成功。30天死亡率为3%，住院死亡率为6%。无心肌梗死或卒中引起的并发症。截瘫（3例患者）与交叉钳夹时间（<30分钟，0/18; >30分钟，3/13 [p < 0.001]）和动脉瘤远端范围（局限性，0/22;广泛性，3/9 [p < 0.001]）相关。短暂性肾功能衰竭（2例患者）与阻断时间相关（<30分钟，0/18; >30分钟，2/13 [p < 0.001]）。这一经验支持使用简单的主动脉交叉夹闭术治疗主动脉弓远端动脉瘤，特别是如果可以快速修复的话。
The surgical approach to aneurysms involving the transverse aortic arch usually requires either techniques for perfusion or hypothermic circulatory arrest. A simplified approach may be warranted when the aneurysmal process begins in the distal aortic arch and spares the innominate artery. Between November, 1975, and January, 1984, 32 patients (22 men, 10 women; median age 61 years) underwent repair of aneurysms of the distal aortic arch by simple cross-clamping of the diseased aortic segment In each, the aneurysm arose distal to the innominate artery and involved the arch at the origin of the left subclavian or left common carotid artery. Proximal control was achieved by cross-clamping the aortic arch between the innominate and left carotid arteries. No shunts or extracorporeal bypass circuits were employed. Proximal hypertension was controlled by sodium nitroprusside infusion. All patients were heparinized. A mean aortic cross-clamp time of 27 ± 10 minutes was required for Dacron graft replacement in 28 patients and Dacron patch repair in three patients. Surgical repair was accomplished successfully in 32 patients. The 30 day mortality was 3% with an in-hospital mortality of 6%. There were no complications as a result of myocardial infarction or stroke. Paraplegia (three patients) was related to cross-clamp time (<30 minutes, 0/18; >30 minutes, 3/13 [p < 0.001]) and distal extent of the aneurysm (localized, 0/22; extensive, 3/9 [p < 0.001]). Transient renal failure (two patients) was related to cross-clamp time (<30 minutes, 0/18; >30 minutes, 2/13 [p < 0.001]). This experience supports the use of simple aortic cross-clamping for aneurysms of the distal aortic arch, especially if an expeditious repair can be accomplished.