Aorta-Iliac Bypass in Thoracoabdominal Aortic Aneurysm Repair in Young Chinese Patients.
BACKGROUND
Many surgical methods of thoracoabdominal aortic aneurysm repair (TAAAR) have been introduced over the past several decades, with varying degrees of success. We developed an aorta-iliac bypass technique to treat thoracoabdominal aortic aneurysm (TAAA) in young Chinese patients. The aim of this study is to evaluate the results of this technique intraoperatively and postoperatively.


METHODS
From June 2014 to March 2015, 28 patients underwent TAAAR using aorta-iliac bypass technique. A four-branched tetrafurcate graft was used. Two branches of the graft are sutured to bilateral common iliac arteries in an end-to-side fashion. The trunk of the graft was sutured to the proximal descending aorta in an end-to-end fashion. Then aorta-iliac bypass was established, and the lower extremities, viscera organ and spinal cord (SC) obtained perfusion from proximal descending aorta via the bypass graft. The thoracic and abdominal aorta were clamped in a staged fashion. The patent segmental arteries (SAs), and visceral arteries (coeliac trunk, superior mesenteric arteries, and renal arteries) were reattached sequentially. Evoked potential (EP) monitoring was adopted to assess the SC ischaemia throughout the procedure. The postoperative outcomes and follow-up results of this technique were evaluated.


RESULTS
There was no in-hospital mortality. Complications included acute kidney dysfunction and pulmonary haemorrhage in one case (3.6%) each. The SAs were reattached in all cases. The EP wave disappeared after proximal descending aorta was clamped, and gradually recovered after the patent SAs reattached. The median follow-up after operation was eight months (range, 1-10 months). There was no delayed neurologic deficit or late death.


CONCLUSIONS
Thoracoabdominal aortic aneurysm repair using aorta-iliac bypass may be a simple and safe choice for young Chinese patients with thoracoabdominal aortic aneurysms.
Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Aortic Disease Center; Department of Cardiovascular Surgery, the First Affiliated Hospital, Kunming Medical University, Kunming, China.
Yu-Yin
YY
Duan
Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Aortic Disease Center.
Yi-Peng
YP
Ge
Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Aortic Disease Center.
Jun
J
Zheng
Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Aortic Disease Center.
Xu-Dong
XD
Pan
Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Aortic Disease Center.
Xiu-Hua
XH
Dong
Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Aortic Disease Center.
Wei-Guo
WG
Ma
Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Aortic Disease Center.
Li-Jian
LJ
Cheng
Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Aortic Disease Center.
Jun-Ming
JM
Zhu
Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Aortic Disease Center.
Yong-Min
YM
Liu
Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Aortic Disease Center. Electronic address: lizhongsun@outlook.com.
Li-Zhong
LZ
Sun
D000328:Adult; D017544:Aortic Aneurysm, Abdominal / Q000503:physiopathology / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000503:physiopathology / Q000601:surgery; D044466:Asian People; D002681:China; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005071:Evoked Potentials; D005260:Female; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic; D012189:Retrospective Studies
Aorta-iliac bypass; Evoked potentials; Mortality; Spinal cord injury; Thoracoabdominal aortic aneurysm repair