内转流结合外转流技术在主动脉弓部原位三开窗术中的应用

Combined internal and external blood shunt technologies for the in-situ three-fenestration revascularization of aortic arch

目的总结使用内转流结合外转流技术在主动脉弓部原位三开窗全腔内手术中行脑保护的应用经验。方法2017年2月至2018年6月,我科采用原位三开窗技术治疗主动脉弓部病变患者8例,其中主动脉夹层3例,主动脉瘤2例,TEVAR术后患者3例。术中利用血管鞘开窗结合颈动脉转流管,采用内转流结合外转流的方法行术中脑保护,并行术中TCD监测脑部血流情况。结果所有手术顺利完成,术中TCD检测显示在主动脉支架覆盖三分支时,脑部无明显缺血。平均脑保护时间(17.62±6.87)min。术后一例患者出现一过性脑缺血,一例患者发生脑梗。结论内转流结合外转流的脑保护策略可以较好的保持脑部血流,为原位三开窗手术中一种简单可行的手术策略,但不能完全避免神经并发症。

Objective To summarize the brain protection application experiences of combined internal and external blood shunt technologies for the in-situ three-fenestration revascularization of aortic arch.Methods From Feb 2017 to Jun 2018,8 patients with aortic arch leisons were treated by the in-situ three-fenestration techniques,including 3 aortic dissection,2 aortic aneurysm,3 postoperative TEVAR patients.We adopt the method of internal and external blood shunt technologies for brain protection using the vascular sheath for fenestration combined with carotid shunt tube skills,and used TCD to monitor the blood flow of brain.Results All operations completed successfully,and TCD showed no significant cerebral ischemia when aortic stent was used to cover the three branches of the aortic.The mean time of brain protection was(17.62±6.87)minutes.One patient developed transient cerebral ischemia after surgery,and another one developed cerebral infarction.Conclusions The brain protection strategy of internal bypass combined with external converter technology maintain the brain blood flow,while is simple and feasible,it cannot completely avoid neurological complications.