Surgical treatment of aortic dissections: initial experience with the adventitial inversion technique.
BACKGROUND
The adventitial inversion technique obliterates the false lumen and converts a dissected aorta into a conduit with tough adventitia on the inside and outside. Dacron grafts can be anastomosed to the aorta with fine sutures, which hold without tears.


METHODS
From August 1995 to March 1997, we treated 6 patients with acute dissecting aneurysms. Three aneurysms were type I (A) involving the entire aorta, two type II (A) involving the ascending aorta, and one type III (B) involving the thoracoabdominal aorta. Circulatory arrest was used in 3 patients, 1 with type I aneurysm (A), 1 type II (A), and 1 type III (B).


RESULTS
All Dacron-aorta anastomoses held sutures well and did not bleed intraoperatively or postoperatively. One patient (type II [A]) died of intraoperative low cardiac output. In patients with type I (A) aneurysms, the false lumen was obliterated, but 1 patient required resection of a 6-cm abdominal aortic aneurysm.


CONCLUSIONS
The adventitial inversion technique is a safe technique for the treatment of acute dissecting aneurysms, which facilitates operation and solves the problem of intraoperative or postoperative bleeding due to tissue friability.
García-Rinaldi
R
R
Division of Cardiovascular Surgery, Pavía Heart Institute, San Juan, Puerto Rico 00910. garciarinald@isla.net
Carballido
J
J
Mojica
J
J
Soltero
E R
ER
Curcic
S
S
Barceló
J
J
Porro
R
R
D000208:Acute Disease; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D000784:Aortic Dissection / Q000145:classification / Q000473:pathology / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000145:classification / Q000473:pathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000145:classification / Q000473:pathology / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002303:Cardiac Output, Low / Q000209:etiology; D002423:Cause of Death; D004547:Elastic Tissue / Q000601:surgery*; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D011093:Polyethylene Terephthalates; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D012449:Safety; D015996:Survival Rate; D013536:Suture Techniques / Q000295:instrumentation; D017539:Tunica Intima / Q000601:surgery
D011093:Polyethylene Terephthalates