升主动脉-颈内动脉自体静脉转流治疗累及左颈总动脉起始部的巨大真性动脉瘤

目的探讨累及左颈总动脉起始部的巨大真性动脉瘤的手术方法。方法回顾性总结1997年2月至2004年6月间3例该病患者的临床资料，均行手术治疗：胸部正中切口显出前纵隔，切开心包及其返折，显露心脏及其大血管，联合颈部切口显出动脉瘤全貌，升主动脉-颈内动脉自体静脉转流后，于主动脉弓上切除动脉瘤。结果3例均于术后7d治愈出院，分别随访8月、5年、7年无动脉瘤复发。结论利用自体静脉行升主动脉-颈内动脉移植技术，经胸部正中切口根治累及左颈总动脉起始部的巨大动脉瘤，具有显露清晰、操作方便、无须切开胸腔、创伤小、恢复快的优点，是一种较好的手术方案。     

Technical Strategy in a Patient with Symptomatic Thoracic Aneurysm Near the Origin of the Left Subclavian Artery and Left Internal Thoracic Artery Coronary Graft

Abstract Thoracic endovascular aortic repair (TEVAR) is a safe and reliable technique utilized in the treatment for aortic aneurysms. However, in up to 40% of patients, devices are typically placed over the left subclavian artery (LSA) origin. In this report, we present a case of a successful TEVAR procedure following the transposition of the LSA with protective carotico‐axillary/carotid bypass in a patient with a patent left internal thoracic artery (LITA)‐left anterior descending (LAD) coronary artery bypass graft and right internal carotid artery (ICA) occlusion. (J Card Surg 2012;27:725‐727)     

A Giant Thrombosed Aneurysm of the Petrous Carotid Artery Presenting with Cavernous Sinus Syndrome: Case Report

Aneurysms involving the petrous Carotid artery are rare and a review of the literature demonstrates that the mode of clinical presentation depends on the direction of expansion of the aneurysmal sac. The eighth nerve is the most commonly affected, followed by the fifth nerve, sixth nerve and seventh nerve, respectively. There has not been reported to date a lesion presenting with cavernous sinus syndrome. We present the case of a 46-year-old woman who complained of left facial pain and pan-ophthalmoplegia, and was shown to have a giant thrombosed aneurysm of the petrous carotid artery extending into the cavernous sinus. Because preoperative evaluation of the patient revealed good collateral flow, proximal balloon occlusion of the left internal carotid artery was performed. Neurological symptoms of the patient resolved 2 months after surgery except for the size of the left pupil. We conclude that an aneurysm of the petrous carotid artery should be included in the differential diagnosis of cases presenting with a cavernous sinus syndrome. Early diagnosis followed by definitive treatment is important for the alleviation of clinical symptoms associated with this lesion.     

Staged Open and Endovascular Repair of Thoracoabdominal Aneurysms Using the Common Carotid Artery

The purpose of this study was to demonstrate the feasibility of staged open and endoluminal repair of complex thoracoabdominal aneurysms. We report the management of two patients with a staged, open abdominal and endoluminal thoracic repair of Crawford extent II aneurysms, where iliofemoral access was impossible and thoracic repair effected by endograft deployment via a common carotid artery. From this experience we conclude that staged open and endovascular repair for both ruptured and elective Crawford extent II thoracoabdominal aneurysms can be performed using the common carotid artery, when anatomy is favorable.     

Clinical Results of Cardiopulmonary Bypass with Selective Cerebral Perfusion for Aneurysm of the Ascending Aorta and the Aortic Arch

The purpose of this report is to describe our experience using cardiopulmonary bypass with selective cerebral perfusion in 10 patients whose aneurysms required cross-clamping the aorta and brachiocephalic vessels. Cerebral perfusion was carried out with individual roller pumps. Flow rate was 11.2 ± 4.8 ml per kilogram of body weight per minute to the right axillary artery, 8.5 ± 1.0 to the right common carotid artery, 7.0 ± 2.0 to the left common carotid artery, and 3.9 to the left subclavian artery. All the patients came off bypass smoothly, and only 3 required small amounts of inotropic agents postoperatively. One patient with mycotic aneurysm died in the fourth postoperative week of massive bleeding due to disruption of the suture line. No cerebral complications were experienced. The operative results of this series suggest the usefulness of cardiopulmonary bypass with selective cerebral perfusion, and reasonably favorable outlook for patients with aneurysm involving the aortic arch and the ascending aorta.     

Concomitant Carotid Endarterectomy and Coronary Bypass Surgery: Should Cardiopulmonary Bypass Be Used for the Carotid Procedure?

Abstract Background and Objectives: With the increasing age of patients undergoing coronary artery bypass grafting (CABG), a greater number have associated clinically significant carotid disease. This study determined the morbidity and mortality for combined carotid endarterectomy (CEA)/CABG using cardiopulmonary bypass (CPB) for both procedures versus a combined approach using CPB only during CABG. Patients and Methods: Between 1993 and 2000, 65 patients (Group I) underwent combined CEA and CABG using CPB for both surgical procedures and 88 patients (Group II) underwent combined CEA and CABG using CPB only during CABG. The demographic, clinical, and carotid and coronary angiographic data were similar between groups. In Group I, 22 (33.8%) patients and 32 (36%) patients in Group II presented with contralateral carotid artery stenosis. Results: CPB time was significantly longer in Group I, 127 ± 21 minutes versus 98 ± 11 minutes in Group II patients (p = 0.001). The incidence of surgical revision for bleeding and deep sternal wound infection was higher in Group I patients, 2 (3%) versus 1 (1.1%) and 5 (7.7%) versus 2 (2.2%), respectively, but not significant. Hospital mortality in Group I was 6% (4 patients) versus 5.7% (5 patients) in Group II (p = ns). Neurologic complications occurred in 4 (6%) and 5 (5.7%) patients in Group I and II, respectively (p = ns). Postoperative renal dysfunction was more common in Group I patients (22 [33.8%]) then in Group II patients 16 (19%) (p = 0.04). Of these patients, (16 [19%]) 8 (12.3%) in Group I and 6 (6.8%) in Group II required postoperative ultrafiltration (p = ns). Infectious complications were more frequent in Group I patients, 5 (7.7%) versus 2 (2.3%), but not statistically significant (p = ns). Overall actuarial survival at 1, 3, and 5 years, including all deaths, was 92%, 88%, and 82% in Group I versus 93%, 86%, and 81% in Group II (p = ns). Overall freedom from stroke at 5 years was 87.5% in Group I and 86.4% in Group II. Conclusions: We conclude that combined CEA/CABG using CPB only during the myocardial revascularization procedure remains the technique of choice in patients with coronary and carotid artery disease, offering better outcome in terms of perioperative morbidity than a combined CEA/CABG using CPB for both procedures.