山梨医科大学雑誌　第10巻4号　111-119(1995)

Surgical Management of Atherosclerotic Aneurysms of the Distal Aortic
Arch Using a Temporary Bypass Graft Method

Yusuke TADA, Kihachiro KAMIYA, Shunya SHINDO, 0samu SUZUKI, Tadao ISHIMOTO,
Atsuhiko TAKAGI, Osamu SATO, Tetsuro MIYATA, Takatoshi FURUYA,
and Masakazu NOBORI

Abstract: We report a unique method for the repair of atherosclerotic aneurysms of the distal aortic arch and the surgical results of this method. During the past 10 years, 34 patients have undergone repair of distal aortic arch aneurysms using temporary bypass graft at our institution; 31 elective procedures and 3 emergency procedures were performed. During aortic occlusion, distal perfusion was maintained through a temporary bypass which was usually created between the right axillary artery and the left external iliac artery. In 31 patients, aneurysms were repaired via left thoracotomy at the 4th intercostal space, and in the remaining 3 patients, a median sternotomy wifh left thoracotomy was used to approach the aneurysm because the aneurysm was in proximity to the orifice of the left common carotid artery. The aortic aneurysm was repaired by tube grafting in 29 patients, and by patch grafting in 5 patients. The mean ratio of lower extremity blood pressure to radial artery pressure during aortic occlusion was 0.69 (SE 0.19) in patients with temporary bypass using low porosity woven 14 mm Dacron grafts, and 0.86 (SE 0.09) in patients with the bypass using 16 mm knitted Dacron grafts (p<0.05). Postoperative complications included thalamic bleeding in 1 patient, pneumonia in 5 patients, acute renal failure in 1 patient, and paraplegia in 2 patients. Early surgical mortality within 30 postoperative days was 2.9% (n=1) and in-hospital mortality was 8.8% (n=3). The cause of early postoperative death was graft infection subsequent to postoperative pneumonia.
The surgical results from temporary bypass grafts are comparable to results obtained with cardiopulmonary bypass reported in the recent Japanese literature.

Key words: Distal aortic arch aneurysm, Temporary bypass method, Cerebral atheromatous embolization, Deep hypothermia, Selective cerebral perfusion, Retrograde cerebral perfusion




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