同期股-股轉流術在急性 A 型主動脈夾層合并嚴重單側下肢灌注不良手術中的應用_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

孫科雄 , 張力 , 高夏 , 崔聰 , 張向輝 , 肖長波 , 張亞飛 , 武剛 ,  王平凡

河南省胸科醫院（鄭州 450003）;

Corresponding?author：

王平凡, Email: xinyuskx@126.com

Keywords：

主動脈夾層; 下肢灌注不良; 股-股轉流術

DOI：

10.7507/1007-4848.202002041

Video：

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目的評估同期股-股轉流術在急性 A 型主動脈夾層合并嚴重單側下肢灌注不良手術中的應用。方法篩選 2013 年 5 月至 2019 年 5 月我院急性 A 型主動脈夾層合并嚴重單側下肢灌注不良患者 21 例，其中男 14 例、女 7 例，平均年齡（42.3±8.2）歲。左下肢受累 12 例，右下肢受累 9 例。所有患者在深低溫停循環下手術治療，同期行股動脈-股動脈人工血管轉流術。結果術后急性腎功能衰竭并行連續性腎臟替代治療 5 例，下肢缺血相關并發癥 3 例，包含下肢壞死 1 例和骨筋膜室綜合征 2 例。因截肢術后多器官功能衰竭死亡 1 例。術后存活 20 例，隨訪 5 個月至 3 年，效果滿意。結論急性 A 型主動脈夾層合并嚴重單側下肢灌注不良手術同期行股-股轉流術是一種簡便有效的方法，不會因肢體缺血時間延長而增加術后并發癥，同時由于缺血肢體早期的低溫灌注減少了下肢缺血-再灌注損傷的發生。

Citation： 孫科雄, 張力, 高夏, 崔聰, 張向輝, 肖長波, 張亞飛, 武剛, 王平凡. 同期股-股轉流術在急性 A 型主動脈夾層合并嚴重單側下肢灌注不良手術中的應用. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(9): 1103-1106. doi: 10.7507/1007-4848.202002041 Copy

1.	Gennari M, Arlati FG, Polvani G, <italic>et al</italic>. Lower limb ischemia management in acute Stanford type A aortic dissection. J Cardiovasc Surg (Torino), 2018, 59(2): 297-299.
2.	Uchida K, Karube N, Kasama K, <italic>et al</italic>. Early reperfusion strategy improves the outcomes of surgery for type A acute aortic dissection with malperfusion. J Thorac Cardiovasc Surg, 2018, 156(2): 483-489.
3.	Charlton-Ouw KM, Sritharan K, Leake SS, <italic>et al</italic>. Management of limb ischemia in acute proximal aortic dissection. J Vasc Surg, 2013, 57(4): 1023-1029.
4.	Goda M, Imoto K, Suzuki S, <italic>et al</italic>. Risk analysis for hospital mortality in patients with acute type A aortic dissection. Ann Thorac Surg, 2010, 90(4): 1246-1250.
5.	Preece R, Srivastava V, Akowuah E, <italic>et al</italic>. Should limb revascularization take priority over dissection repair in type A aortic dissection presenting as isolated acute limb ischaemia. Interact Cardiovasc Thorac Surg, 2017, 25(4): 643-646.
6.	Gottardi R, Resetar M, Bacher B, <italic>et al</italic>. Concomitant femoro-femoral bypass graft during surgery for acute type A dissection to treat lower limb malperfusion. Ann Thorac Surg, 2015, 99(1): 307-309.
7.	任偉, 王志維, 吳智勇, 等. 合并急性下肢缺血的 Stanford A 型主動脈夾層的臨床療效分析. 中華胸心血管外科雜志, 2019, 35(3): 154-158.
8.	Williams DM, Lee DY, Hamilton BH, <italic>et al</italic>. The dissected aorta: partⅢ. Anatomy and radiologic diagnosis of branch-vessel compromise. Radiology, 1997, 203(1): 37-44.
9.	Sfyroeras GS, Rubio V, Pagan P, <italic>et al</italic>. Endovascular management of malperfusion in acute type B aortic dissections. J Endovasc Ther, 2011, 18(1): 78-86.
10.	Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg, 2002, 10(6): 620-630.
11.	Wuest W, Goltz J, Ritter C, <italic>et al</italic>. Fenestration of aortic dissection using a fluoroscopy-based needle re-entry catheter system. Cardiovasc Intervent Radiol, 2011, 34(Suppl 2): S44-S47.
12.	Deeb GM, Williams DM, Bolling SF, <italic>et al</italic>. Surgical delay for acute type A dissection with malperfusion. Ann Thorac Surg, 1997, 64(6): 1669-1675.
13.	Williams DM, Lee DY, Hamilton BH, <italic>et al</italic>. The dissected aorta: percutaneous treatment of ischemic complications—principles and results. J Vasc Interv Radiol, 1997, 8(4): 605-625.
14.	Ikeda A, Kudo Y, Konishi T, <italic>et al</italic>. Surgical fenestration for lower limb ischemia developing from chronic type B aortic dissection: a report of 2 cases. Ann Vasc Surg, 2016, 31: 208.
15.	Braverman AC. Acute aortic dissection: clinician update. Circulation, 2010, 122(2): 184-188.
16.	Patel HJ, Williams DM, Dasika NL, <italic>et al</italic>. Operative delay for peripheral malperfusion syndrome in acute type A aortic dissection: a long-term analysis. J Thorac Cardiovasc Surg, 2008, 135(6): 1288-1295.
17.	孫立忠, 齊瑞東, 朱俊明, 等. 孫氏手術 (Sun's procedure)—復雜型 A 型主動脈夾層手術治療的新標準. 中國醫藥, 2011, 6(z2): 1-3.
18.	Rutherford RB, Baker JD, Ernst C, <italic>et al</italic>. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg, 1997, 26(3): 517-538.
19.	Mowlavi A, Neumeister MW, Wilhelmi BJ, <italic>et al</italic>. Local hypothermia during early reperfusion protects skeletal muscle from ischemia-reperfusion injury. Plast Reconstr Surg, 2003, 111(1): 242-250.

1. Gennari M, Arlati FG, Polvani G, <italic>et al</italic>. Lower limb ischemia management in acute Stanford type A aortic dissection. J Cardiovasc Surg (Torino), 2018, 59(2): 297-299.
2. Uchida K, Karube N, Kasama K, <italic>et al</italic>. Early reperfusion strategy improves the outcomes of surgery for type A acute aortic dissection with malperfusion. J Thorac Cardiovasc Surg, 2018, 156(2): 483-489.
3. Charlton-Ouw KM, Sritharan K, Leake SS, <italic>et al</italic>. Management of limb ischemia in acute proximal aortic dissection. J Vasc Surg, 2013, 57(4): 1023-1029.
4. Goda M, Imoto K, Suzuki S, <italic>et al</italic>. Risk analysis for hospital mortality in patients with acute type A aortic dissection. Ann Thorac Surg, 2010, 90(4): 1246-1250.
5. Preece R, Srivastava V, Akowuah E, <italic>et al</italic>. Should limb revascularization take priority over dissection repair in type A aortic dissection presenting as isolated acute limb ischaemia. Interact Cardiovasc Thorac Surg, 2017, 25(4): 643-646.
6. Gottardi R, Resetar M, Bacher B, <italic>et al</italic>. Concomitant femoro-femoral bypass graft during surgery for acute type A dissection to treat lower limb malperfusion. Ann Thorac Surg, 2015, 99(1): 307-309.
7. 任偉, 王志維, 吳智勇, 等. 合并急性下肢缺血的 Stanford A 型主動脈夾層的臨床療效分析. 中華胸心血管外科雜志, 2019, 35(3): 154-158.
8. Williams DM, Lee DY, Hamilton BH, <italic>et al</italic>. The dissected aorta: partⅢ. Anatomy and radiologic diagnosis of branch-vessel compromise. Radiology, 1997, 203(1): 37-44.
9. Sfyroeras GS, Rubio V, Pagan P, <italic>et al</italic>. Endovascular management of malperfusion in acute type B aortic dissections. J Endovasc Ther, 2011, 18(1): 78-86.
10. Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg, 2002, 10(6): 620-630.
11. Wuest W, Goltz J, Ritter C, <italic>et al</italic>. Fenestration of aortic dissection using a fluoroscopy-based needle re-entry catheter system. Cardiovasc Intervent Radiol, 2011, 34(Suppl 2): S44-S47.
12. Deeb GM, Williams DM, Bolling SF, <italic>et al</italic>. Surgical delay for acute type A dissection with malperfusion. Ann Thorac Surg, 1997, 64(6): 1669-1675.
13. Williams DM, Lee DY, Hamilton BH, <italic>et al</italic>. The dissected aorta: percutaneous treatment of ischemic complications—principles and results. J Vasc Interv Radiol, 1997, 8(4): 605-625.
14. Ikeda A, Kudo Y, Konishi T, <italic>et al</italic>. Surgical fenestration for lower limb ischemia developing from chronic type B aortic dissection: a report of 2 cases. Ann Vasc Surg, 2016, 31: 208.
15. Braverman AC. Acute aortic dissection: clinician update. Circulation, 2010, 122(2): 184-188.
16. Patel HJ, Williams DM, Dasika NL, <italic>et al</italic>. Operative delay for peripheral malperfusion syndrome in acute type A aortic dissection: a long-term analysis. J Thorac Cardiovasc Surg, 2008, 135(6): 1288-1295.
17. 孫立忠, 齊瑞東, 朱俊明, 等. 孫氏手術 (Sun's procedure)—復雜型 A 型主動脈夾層手術治療的新標準. 中國醫藥, 2011, 6(z2): 1-3.
18. Rutherford RB, Baker JD, Ernst C, <italic>et al</italic>. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg, 1997, 26(3): 517-538.
19. Mowlavi A, Neumeister MW, Wilhelmi BJ, <italic>et al</italic>. Local hypothermia during early reperfusion protects skeletal muscle from ischemia-reperfusion injury. Plast Reconstr Surg, 2003, 111(1): 242-250.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

同期股-股轉流術在急性 A 型主動脈夾層合并嚴重單側下肢灌注不良手術中的應用

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