Central Cannulation by Seldinger Technique: A Reliable Method in Type A Aortic Dissection Repairs
Central Cannulation by Seldinger Technique: A Reliable Method in Type A Aortic Dissection Repairs
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DOI：
10.12659/msm.890813
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发表时间：
2014-11-22
影响因子：
3.1
通讯作者：
Ohri, Sunil K.
中科院分区：
文献类型：
--
作者：
Goeboeloes, Laszlo;Ugocsai, Peter;Ohri, Sunil K.
背景资料：累及外周大血管的广泛A型主动脉夹层可使体外循环插管部位的选择复杂化。我们开始采用Seldinger技术的主动脉弓上的血管的真腔直接插管，并评估了这种访问技术作为替代动脉流入目标在主动脉surgery.Material/Methods的有效性：24例连续患者（平均年龄：59 +/- 14岁）进行了A型主动脉夹层修复使用选择性顺行脑灌注。直接主动脉插管14例，锁骨下穿刺6例，股动脉穿刺4例。评估围手术期因素以确定主动脉弓直接插管方法的可靠性和最终获益。结果：无手术死亡，30天累积死亡率为25%（6）。未观察到永久性神经功能缺损; 1例患者发生一过性变化（4%）。直接入路组达到循环停止的时间最短，平均27 +/- 11（CI：20.6-33.3）min，股动脉插管和锁骨下入路分别为43 +/- 22（28.0-78.0）min（p=0.058）和32 +/- 8（23.6-40.4）min（p=0.34）。直接弓插管导致最好的肾功能在第一个72小时后手术和类似的特点，观察到乳酸levels.Conclusions：超声引导下直接插管的主动脉弓上使用Seldinger技术是一种可靠的方法在夹层修复。及时的顺行灌注不仅提供了脑保护，而且还提供了外周器官和组织保护，这在该高危患者组中是一个优势。
Background: Extensive type A aortic dissections that involve peripheral great vessels can complicate the choice of a cannulation site for cardiopulmonary bypass. We started to employ direct cannulation of the true lumen on the concavity of the aortic arch by Seldinger technique and evaluated the efficacy of this access technique as an alternative arterial inflow target in aortic surgery.Material/Methods: Twenty-four consecutive patients (mean age: 59 +/- 14 years) underwent type A aortic dissection repair using selective antegrade cerebral perfusion. Direct aortic cannulation was used in 14 cases, subclavian access in 6 patients, and femoral entry in 4 patients. Perioperative factors were evaluated to identify the reliability and eventual benefits of direct cannulation method at the aortic arch.Results: There were no operative deaths and cumulative 30-day mortality rate was 25% (6). Permanent neurological deficits were not observed; in 1 patient transient changes occurred (4%). Time to reach circulatory arrest was the shortest in the direct access group, with mean 27 +/- 11 (CI: 20.6-33.3) min vs. 43 +/- 22 (28.0-78.0) min (p=0.058) and 32 +/- 8 (23.6-40.4) min (p=0.34) by femoral cannulation and subclavian entry, respectively. Direct arch cannulation resulted in the best renal function in the first 72 h after surgery and similar characteristics were observed in lactic acid levels.Conclusions: Ultrasound-guided direct cannulation on the concavity of the aortic arch using a Seldinger technique is a reliable method in dissection repairs. Prompt antegrade perfusion provides not only cerebral but also peripheral organ and tissue protection, which is an advantage in this high-risk group of patients.