| Aortic Dissection Complicated
by Atherosclerotic Aneurysm |
(Department of Cardiovascular Surgery, National
Hospital Tokyo Disaster Medical Center, Tachikawa, Japan and The
Second Department of Surgery, Nihon University School of Medicine*,
Tokyo, Japan)
| Saeki Tsukamoto |
Shoji Shindo |
Masahiro Obana |
| Kenji Akiyama* |
Motomi Shiono* |
Nanao Negishi* |
|
From January 1, 1999 through December
31, 2001, 152 cases of aortic dissection (77 cases of Stanford
Type A and 75 Type B) were treated in our department. Among those
cases, 25 patients (10 Type A (13.0%) and 15 Type B (20.0%))
were accompanied by atherosclerotic aneurysm. The mean age of
onset of those cases was 71.4±9.8 years. Because those patients
were older, it is necessary to pay attention to decide on treatment
strategy and surgical procedure. In order to prevent atherosclerotic
plaque being pumped into the brain vessel, we devised the following
surgical procedure and perfusion method of cardiopulmonary bypass
as follows; 1. In cases of retrograde perfusion from the femoral
artery through the aneurysm, we usually pump the blood more slowly
and gently than the antegrade perfusion. 2. We reduce the perfusion
pressure after the heart beat changes to ventricular fibrillation.
3. After distal anastomosis of the vascular prosthesis, the blood
is pumped from its perfusion branch. An initial tear was located
in the spindle-shaped aneurysm in 3 cases (2.0%). Of 11 cases
that aortic dissection was in contact with the atherosclerotic
aneurysm, 2 cases of saccular shaped aneurysm terminated the
dissection. In the 9 cases of spindle shaped aneurysm, however,
the dissection involved the aneurysm, suggesting that the effect
of aneurysm on the dissection depended on the aneurysmal shape.
When the dissection coexists with aneurysm in different portions
of the aorta, re-dissection may extend into the aneurysm. Therefore,
careful decision making on the timing of surgery is necessary
for abdominal aortic aneurysm complicated with aortic dissection,
even when treating conservatively.
Jpn. J. Cardiovasc. Surg. 32：201 -205（2003) |
|
