Journal of Chest Surgery

  • 제42권3호
  • /
  • Pages.375-379
  • /
  • 2009
  • /
  • 2765-1606(pISSN)
  • /
  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
권호 표지

원위부에 스텐트가 포함된 인조혈관 (Frozen Elephant Trunk)을 이용한 대동맥궁 동맥류 수술

Aortic Arch Aneurysm Repair using a Prosthetic Graft with a Pre-mounted Distal Stent (Frozen Elephant Trunk)

  • 장형우 (분당서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 정의석 (분당서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 최진호 (분당서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 임청 (분당서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 박계현 (분당서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실)
  • Chang, Hyoung-Woo (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Chung, Eui-Suk (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Choi, Jin-Ho (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Lim, Cheong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Park, Kay-Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • 발행 : 2009.06.05
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

원위부 대동맥궁에 발생한 대동맥류에 대한 수술을 위해서는 정중흉골 절개술 또는 측방개흉을 통한 수술방법이 있으나 문합 부위의 시야 확보가 용이하지 않은 경우가 자주 있다. 수술 대신 중재시술로 스텐트 그라프트를 삽입하는 방법 또한 가능하지만 동맥류보다 근위부에 충분한 고정 거리를 확보하기 위해서 대동맥궁 분지 일부를 결찰하고 우회로를 조성해야 할 필요가 있다는 제한이 있다. 저자들은 이들 방법의 장점을 취하고자 정중흉골절개술 후 완전 순환 정지 상태에서 대동맥궁을 치환하는 수술 중 외과적 문합 대신 스텐트 그라프트를 이용하여 인조혈관 원위부를 고정하는 방법을 취하여 양호한 결과를 얻은 경험을 보고한다.

Difficulty in exposing anastomotic sites is a frequently encountered problem during surgical repair of a distal aortic arch aneurysm via median sternotomy or lateral thoracotomy. Endovascular repair has th limitation that it usually requires surgical rerouting of some of the brachiocephalic branches in order to get sufficient length for proximal fixation of the stent-graft. To take advantage of each approach, we fixed the distal end of the prosthetic graft by means of a pre-mounted metallic stent instead of performing conventional surgical anastomosis during the repair of distal arch aneurysms with using median sternotomy and hypothermic circulatory arrest. We report here on our experience with such 3 patients.

키워드

참고문헌

  1. Spielvogel D, Lansman SL, Griepp RB. Aortic arch replacement/Selective antegrade perfusion. Operative Techniques in Thoracic and Cardiovascular Surgery 2005;10:23-44 https://doi.org/10.1053/j.optechstcvs.2005.02.001
  2. Czerny M, Gottardi R, Zimpfer D, et al. Transposition of supraaortic branches for extended endovascular arch repair. Eur J Cardiothorac Surg 2006;29:709-13 https://doi.org/10.1016/j.ejcts.2005.12.058
  3. Jakob H, Tsagakis K, Tossios P, et al. Combining classic surgery with descending stent grafting for acute debakey type I dissection. Ann Thorac Surg 2008;86:95-102 https://doi.org/10.1016/j.athoracsur.2008.03.037
  4. Gorlitzer M, Weiss G, Thalmann M, et al. Combined surgical and endovascular repair of complex aortic pathologies with a new hybrid prosthesis. Ann Thorac Surg 2007;84:1971-7 https://doi.org/10.1016/j.athoracsur.2007.07.010
  5. Cho KJ, Bang JH, Woo JS, et al. A case of total aortic arch replacement with root plasty with right coronary artery bypass and distal open stent-graft insertion in acute type I aortic dissection. Korean J Thorac Cardiovasc Surg 2005;38:434-7
  6. Usui A, Ueda Y, Watanabe T, et al. Comparative clinical study between endovascular stent grafting on open surgery and conventional graft replacement for distal arch aneurysm. J Artificial Organ 2001;4:283-7 https://doi.org/10.1007/BF02480018
  7. Usui A, Ueda Y, Watanabe T, et al. Clinical results of implantation of an endovascular covered stent-graft via mid-sternotomy for distal aortic arch aneurysm. Cardiovasc Surg 2000;7:545-9 https://doi.org/10.1016/S0967-2109(00)00066-1
  8. Usui A, Fujimoto K, Ishiguchi T, et al. Cerebrospinal dysfunction after endovascular stent-grafting via a median sternotomy: the frozen elephant trunk procedure. Ann Thorac Surg 2002;74:S1821-4 https://doi.org/10.1016/S0003-4975(02)04131-0