Active aorto-iliac bypass for thoraco-abdominal aortic aneurysm repair.

Content Provider	Semantic Scholar
Author	Bayly, P. J. M. Cudworth, P. Wyatt, Michael G.
Copyright Year	2001
Abstract	Introduction Another technique described to maintain distal perfusion is the use of a temporary axillo-femoral bypass Surgical repair of thoraco-abdominal aortic aneurysms graft. This has the disadvantage of requiring an additional operative procedure and also relies on left (TAAA) requires interruption of flow to vital structures including the spinal cord, kidneys and viscera. Ischventricular pump function. This paper describes a modification of this technique, using an extra-coraemic damage will occur if the clamp time is prolonged, and in the absence of distal organ perfusion, poreal proximal-to-distal aortic bypass, driven by an active centrifugal pump. postoperative renal failure is common. In addition, the incidence of paraplegia is markedly reduced by distal perfusion techniques. Technique Application of an aortic cross clamp increases the left ventricular afterload, particularly when the clamp A 63-year-old man presented with a 7 cm thoracois placed on the thoracic aorta, as up to 45% of the abdominal aortic aneurysm. This arose distal to the cardiac output is normally directed to the renal and left subclavian artery, involved the visceral and renal splanchnic circulation. The arterial blood pressure arteries and extended to the aortic bifurcation (Crawabove the clamp may become unsustainably high, ford Type III). Anaesthetic technique included the use resulting in left ventricular failure (LVF), myocardial of a Robertshaw double lumen endobronchial tube for infarction (MI), cerebral haemorrhage and raised one lung ventilation and intraoperative analgesia was intracranial pressure (ICP). Pharmacological approvided by a remifentanil infusion. A thoracic epiproaches to reducing the blood pressure frequently dural was sited but not used until required for post result in further elevation of the ICP. operative analgesia. Right radial and femoral arterial The technique of partial left heart bypass with shuntcatheters were inserted in order to directly monitor ing of blood from the left atrium to a femoral or iliac both proximal and distal blood pressure and a pulartery via a roller or centrifugal pump is widely used monary artery flotation catheter inserted via the right to overcome these problems. Blood is drained from internal jugular vein. A spinal drain placed in the L the left atrium resulting in reduction in left ventricular 3/4 interspace was primed to drain if cerebrospinal preload, the left ventricular stroke volume is therefore fluid (CSF) pressure rose above 10 mmHg. The urinary reduced decreasing the cardiac output, and producing bladder was catheterised. a fall in blood pressure proximal to the aortic clamp. One million units of aprotinin were given over an The distal aorta is retrogradely perfused while the hour, followed by an infusion of 500 000 units per proximal anastomosis is completed. However this hour. Blood suctioned from the surgical wound was technique can only usually be used where facilities for saved for autologous transfusion and processed using cardiopulmonary bypass are available. a Haemonetics Cell Saver. All intravenous fluids were warmed. A Haemonetics Rapid Infusion System was ∗ Please address all correspondence to: M. G. Wyatt, Consultant utilised and a forced air warming blanket was applied Vascular Surgeon, Northern Vascular Centre, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN, U.K. to the patient.
File Format	PDF HTM / HTML
DOI	10.1053/ejvs.2001.1464
PubMed reference number	11563895
Journal	Medline
Volume Number	22
Issue Number	4
Alternate Webpage(s)	https://core.ac.uk/download/pdf/82598424.pdf
Journal	European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
Language	English
Access Restriction	Open
Content Type	Text
Resource Type	Article