KẾT QUẢ DÀI HẠN PHẪU THUẬT CẦU NỐI ĐỘNG MẠCH CHỦ NGỰC - ĐỘNG MẠCH CẢNH - DƯỚI ĐÒN

Abstract

Objectives: The complex stenosis of the branches of the aortic arch is rare, it was the challenge for vascular surgeon to manage. The purpose of thisstudy was review our experience with diagnosis and surgical treatment for complex stenosis of the branches of the aortic arch .Methods: Prospective. Eveluate the clinical characteristics of complex stenosis of the branches of the aortic arches. Diagnosis was based on Dupplex scanning, MSCT and angiography. Intrathoracic bypass was indicated for all cases. Results: From 10/1999 to 10/2011, twelve patients with complex stenosis of the branches of the aortic arch were treated in Choray hospital and Thong nhat hospital. 4 cases stenosis of the carotid and the subclavian artery; 4 cases have stenosis the branchiocephalic artery; and 4had stenosis all of the branches of the aortic arch. 10 cases admission because of chronic upper extremity ischemia. 12 cases had TIA. Takayashu’s disease affected in 6 cases, atherosclerosis was the cause of 6 patients. All patients were diagnosed by Duplex scan, MSCT and arteriography. 2 cases with 99 percent stenosis, the others were completely occluded.Upper partial sternotomy were performed in all cases.; Aorto carotido-subclavian bypass in 7 cases; Aorto bi-carotid bi-subclavian bypass were performed in 4 cases; Branchiocephalo carotid and subclavian bypass in 1 case, PTFE prothesis graft was used in 2 cases. Dacron prothesis was used in the rest .No procedure-related mortality was observed. No stroke. There are 1 wound infection, No restenosis after 12 years follow up.Conclusions: Upper partial sternotomy is a very good approach for ascending aorto carotidosubclavian bypass operation. Ascending aorto carotido subclavian bypass should be done for stenosis of multi-branches.