同期股-股转流术在急性 A 型主动脉夹层合并严重单侧下肢灌注不良手术中的应用_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

孙科雄 , 张力 , 高夏 , 崔聪 , 张向辉 , 肖长波 , 张亚飞 , 武刚 ,  王平凡

河南省胸科医院（郑州 450003）;

Corresponding author：

王平凡, Email: xinyuskx@126.com

Keywords：

主动脉夹层; 下肢灌注不良; 股-股转流术

DOI：

10.7507/1007-4848.202002041

Video：

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目的评估同期股-股转流术在急性 A 型主动脉夹层合并严重单侧下肢灌注不良手术中的应用。方法筛选 2013 年 5 月至 2019 年 5 月我院急性 A 型主动脉夹层合并严重单侧下肢灌注不良患者 21 例，其中男 14 例、女 7 例，平均年龄（42.3±8.2）岁。左下肢受累 12 例，右下肢受累 9 例。所有患者在深低温停循环下手术治疗，同期行股动脉-股动脉人工血管转流术。结果术后急性肾功能衰竭并行连续性肾脏替代治疗 5 例，下肢缺血相关并发症 3 例，包含下肢坏死 1 例和骨筋膜室综合征 2 例。因截肢术后多器官功能衰竭死亡 1 例。术后存活 20 例，随访 5 个月至 3 年，效果满意。结论急性 A 型主动脉夹层合并严重单侧下肢灌注不良手术同期行股-股转流术是一种简便有效的方法，不会因肢体缺血时间延长而增加术后并发症，同时由于缺血肢体早期的低温灌注减少了下肢缺血-再灌注损伤的发生。

Citation： 孙科雄, 张力, 高夏, 崔聪, 张向辉, 肖长波, 张亚飞, 武刚, 王平凡. 同期股-股转流术在急性 A 型主动脉夹层合并严重单侧下肢灌注不良手术中的应用. 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.	任伟, 王志维, 吴智勇, 等. 合并急性下肢缺血的 Stanford A 型主动脉夹层的临床疗效分析. 中华胸心血管外科杂志, 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.	孙立忠, 齐瑞东, 朱俊明, 等. 孙氏手术 (Sun's procedure)—复杂型 A 型主动脉夹层手术治疗的新标准. 中国医药, 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. 任伟, 王志维, 吴智勇, 等. 合并急性下肢缺血的 Stanford A 型主动脉夹层的临床疗效分析. 中华胸心血管外科杂志, 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. 孙立忠, 齐瑞东, 朱俊明, 等. 孙氏手术 (Sun's procedure)—复杂型 A 型主动脉夹层手术治疗的新标准. 中国医药, 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-股转流术在急性 A 型主动脉夹层合并严重单侧下肢灌注不良手术中的应用

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