MULTIPLE SURGICAL TREATMENT OF COMPLEX AORTIC ARCH AND DESCENDING AORTA DISEASE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QIU Hanfan , CHEN Daozhong , CHEN Liangwan , LIN Feng , CAO Hua.

Department of Cardiovascular Surgery, Union Hospital of Fujian Medical University, Fuzhou Fujian, 350001, P.R.China.;

Corresponding author：

Keywords：

Complex aortic arch and descending aorta disease; Endovascular aneurysm repair; Hybrid operation

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Objective To investigate the methods and effectiveness of multi ple surgical treatment for complex aortic arch and descending aorta disease, including cardiopulmonary bypass operation, hybrid operation, and total endovascular aneurysm repair (EVAR). Methods Between October 2006 and September 2011, 48 patients with complex aortic arch and
descending aorta disease were treated. There were 31 males and 17 females, aged from 28 to 81 years (mean, 52.4 years). The disease duration ranged from 1 to 90 days (mean, 10.2 days). There were 30 cases of type B aortic dissection involving the aortic arch, 11 cases of thoracic aortic aneurysm, 3 cases of thoracic pseudoaneurysme, 3 cases of penetrating aortic ulcer, and 1 case of aortoesophageal fistula. Cardiopulmonary bypass operation, hybrid operation, and total EVAR were performed in 15, 12, and 21 cases, respectively. Results In the patients undergoing cardiopulmonary bypass operation, the following complications occurred: 1 case of bleeding, 1 case of coma, 3 cases of psychiatric disorders, 4 cases of pneumonia, 2 cases of acute renal insufficiency, and 2 cases of multi-organ dysfunction; finally 3 patients died. In the patients undergoing hybrid operation, cerebral infarction and renal function failure occurred in 1 case. In the patients undergoing total EVAR, no complication occurred. A total of 41 patients were followed up 2 to 60 months (mean, 28.6 months). Sl ight left subclavian steal syndrome occurred in 3 cases, but self rel ieved. Other patients recovered to normal l ife. Conclusion In the surgical treatments of complex aortic arch and descending aorta disease, cardiopulmonary bypass operation will be gradually replaced by EVAR because of the surgical trauma and risk, hybrid operation is an important technique, and total EVAR will be the future progress.

Citation： QIU Hanfan,CHEN Daozhong,CHEN Liangwan,LIN Feng,CAO Hua.. MULTIPLE SURGICAL TREATMENT OF COMPLEX AORTIC ARCH AND DESCENDING AORTA DISEASE. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(6): 717-720. doi: Copy

1.	王深明. 血管外科学. 北京: 人民卫生出版社, 2011: 403-417.
2.	刘宸铖, 郭应强, 蒙炜, 等. 全主动脉弓置换加支架象鼻手术治疗A型主动脉夹层. 中国胸心血管外科临床杂志, 2009, 16(2): 148-149.
3.	张本, 张卫达, 王晓武, 等. “杂交手术”在DeBakeyⅠ型主动脉夹层治疗中的应用及价值. 南方医科大学学报, 2010, 30(12): 2725-2728.
4.	Pochettino A, Brinkman WT, Moeller P, et al. Antegrade thoracic stent grafting during repair of acute DeBakey I dissection prevents development of thoracoabdominal aortic aneurysms. Ann Thorac Surg, 2009, 88(2): 482-490.
5.	Campbell-Lloyd AJ, Mundy J, Pinto N, et al. Contemporary results following surgical repair of acute type a aortic dissection (AAAD): a single centre experience. Heart Lung Circ, 2010, 19(11): 665-672.
6.	Chen LW, Dai XF, Yang GF, et al. Open-branched stent graft placement makes total arch replacement easier for acute type a aortic dissection. Ann Thorac Surg, 2010, 89(5): 1688-1690.
7.	Chen LW, Dai XF, Zhang GC, et al. Total aortic arch reconstruction with open placement of triple-branched stent graft for acute type A dissection. J Thorac Cardiovasc Surg, 2010, 139(6): 1654-1655.
8.	王平凡, 李潮, 陈良万, 等. 新型三分支主动脉弓覆膜支架治疗Ⅰ型主动脉夹层的研究. 医药论坛杂志, 2009, 30(21): 1-2, 5.
9.	中华医学会外科学分会血管外科学组. 主动脉夹层腔内治疗指南. 中国实用外科杂志, 2008, 28(11): 909-912.
10.	郭伟, 刘小平, 尹太, 等. 主动脉弓部病变腔内修复术的研究. 中国实用外科杂志, 2007, 27(2): 136-138.
11.	Antoniou GA, El Sakka K, Hamady M, et al. Hybrid treatment of complex aortic arch disease with supra-aortic debranching and endovascular stent graft repair. Eur J Vasc Endovasc Surg, 2010, 39(6): 683-690.
12.	Hughes GC, Daneshmand MA, Balsara KR, et al. “Hybrid” repair of aneurysms of the transverse aortic arch: midterm results. Ann Thorac Surg, 2009, 88(6): 1882-1887.
13.	Kotelis D, Geisbüsch P, Hinz U, et al. Short and midterm results after left subclavian artery coverage during endovascular repair of the thoracic aorta. J Vasc Surg, 2009, 50(6): 1285-1292.
14.	陆清声, 景在平. 主动脉弓扩张性疾病的腔内治疗. 外科理论与实践, 2011, 16(2): 126-129.
15.	Sugiura K, Sonesson B, Akesson M, et al. The applicability of chimney grafts in the aortic arch. J Cardiovasc Surg (Torino), 2009, 50(4): 475-481.
16.	舒畅, 罗明尧, 李全明, 等. “烟囱”技术在累及主动脉弓部血管的动脉夹层腔内修复术中的应用. 中国普通外科杂志, 2010, 19(12): 1266-1270.
17.	Ohrlander T, Sonesson B, Ivancev K, et al. The chimney graft: a technique for preserving or rescuing aortic branch vessels in stent-graft sealing zones. J Endovasc Ther, 2008, 15(4): 427-432.
18.	冯睿, 景在平, 赵志青, 等. 主动脉弓上病变的双烟囱法腔内隔绝术. 介入放射学杂志, 2011, 20(7): 510-512.

1. 王深明. 血管外科学. 北京: 人民卫生出版社, 2011: 403-417.
2. 刘宸铖, 郭应强, 蒙炜, 等. 全主动脉弓置换加支架象鼻手术治疗A型主动脉夹层. 中国胸心血管外科临床杂志, 2009, 16(2): 148-149.
3. 张本, 张卫达, 王晓武, 等. “杂交手术”在DeBakeyⅠ型主动脉夹层治疗中的应用及价值. 南方医科大学学报, 2010, 30(12): 2725-2728.
4. Pochettino A, Brinkman WT, Moeller P, et al. Antegrade thoracic stent grafting during repair of acute DeBakey I dissection prevents development of thoracoabdominal aortic aneurysms. Ann Thorac Surg, 2009, 88(2): 482-490.
5. Campbell-Lloyd AJ, Mundy J, Pinto N, et al. Contemporary results following surgical repair of acute type a aortic dissection (AAAD): a single centre experience. Heart Lung Circ, 2010, 19(11): 665-672.
6. Chen LW, Dai XF, Yang GF, et al. Open-branched stent graft placement makes total arch replacement easier for acute type a aortic dissection. Ann Thorac Surg, 2010, 89(5): 1688-1690.
7. Chen LW, Dai XF, Zhang GC, et al. Total aortic arch reconstruction with open placement of triple-branched stent graft for acute type A dissection. J Thorac Cardiovasc Surg, 2010, 139(6): 1654-1655.
8. 王平凡, 李潮, 陈良万, 等. 新型三分支主动脉弓覆膜支架治疗Ⅰ型主动脉夹层的研究. 医药论坛杂志, 2009, 30(21): 1-2, 5.
9. 中华医学会外科学分会血管外科学组. 主动脉夹层腔内治疗指南. 中国实用外科杂志, 2008, 28(11): 909-912.
10. 郭伟, 刘小平, 尹太, 等. 主动脉弓部病变腔内修复术的研究. 中国实用外科杂志, 2007, 27(2): 136-138.
11. Antoniou GA, El Sakka K, Hamady M, et al. Hybrid treatment of complex aortic arch disease with supra-aortic debranching and endovascular stent graft repair. Eur J Vasc Endovasc Surg, 2010, 39(6): 683-690.
12. Hughes GC, Daneshmand MA, Balsara KR, et al. “Hybrid” repair of aneurysms of the transverse aortic arch: midterm results. Ann Thorac Surg, 2009, 88(6): 1882-1887.
13. Kotelis D, Geisbüsch P, Hinz U, et al. Short and midterm results after left subclavian artery coverage during endovascular repair of the thoracic aorta. J Vasc Surg, 2009, 50(6): 1285-1292.
14. 陆清声, 景在平. 主动脉弓扩张性疾病的腔内治疗. 外科理论与实践, 2011, 16(2): 126-129.
15. Sugiura K, Sonesson B, Akesson M, et al. The applicability of chimney grafts in the aortic arch. J Cardiovasc Surg (Torino), 2009, 50(4): 475-481.
16. 舒畅, 罗明尧, 李全明, 等. “烟囱”技术在累及主动脉弓部血管的动脉夹层腔内修复术中的应用. 中国普通外科杂志, 2010, 19(12): 1266-1270.
17. Ohrlander T, Sonesson B, Ivancev K, et al. The chimney graft: a technique for preserving or rescuing aortic branch vessels in stent-graft sealing zones. J Endovasc Ther, 2008, 15(4): 427-432.
18. 冯睿, 景在平, 赵志青, 等. 主动脉弓上病变的双烟囱法腔内隔绝术. 介入放射学杂志, 2011, 20(7): 510-512.

Chinese Journal of Reparative and Reconstructive Surgery

MULTIPLE SURGICAL TREATMENT OF COMPLEX AORTIC ARCH AND DESCENDING AORTA DISEASE

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