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Impact of the Isolated Cerebral Perfusion Technique for Aortic Arch Aneurysm Repair in Patients with a Shaggy Aorta

Objective: Total aortic arch replacement (TAR), particularly in individuals with extensive atherosclerotic alterations, especially shaggy aortas, is more crucial and difficult. The objective of this retrospective investigation was to ascertain if patients with shaggy aortas would respond to modified...

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Autores principales: Sugiyama, Kayo, Watanuki, Hirotaka, Tochii, Masato, Futamura, Yasuhiro, Ishizuka, Koki, Matsuyama, Katsuhiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Japanese College of Angiology / The Japanese Society for Vascular Surgery / Japanese Society of Phlebology 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9816034/
https://www.ncbi.nlm.nih.gov/pubmed/36644259
http://dx.doi.org/10.3400/avd.oa.21-00128
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author Sugiyama, Kayo
Watanuki, Hirotaka
Tochii, Masato
Futamura, Yasuhiro
Ishizuka, Koki
Matsuyama, Katsuhiko
author_facet Sugiyama, Kayo
Watanuki, Hirotaka
Tochii, Masato
Futamura, Yasuhiro
Ishizuka, Koki
Matsuyama, Katsuhiko
author_sort Sugiyama, Kayo
collection PubMed
description Objective: Total aortic arch replacement (TAR), particularly in individuals with extensive atherosclerotic alterations, especially shaggy aortas, is more crucial and difficult. The objective of this retrospective investigation was to ascertain if patients with shaggy aortas would respond to modified isolated cerebral perfusion (ICP). Materials and Methods: Between 2015 and 2020, nine individuals with shaggy aortas who received treatment for arch aneurysms were examined. Four and five patients, respectively, who had arch replacement with traditional selective cerebral perfusion (SCP) and modified ICP, were evaluated, and their short- and long-term results were compared. Results: There were no appreciable variations in the postoperative results between patients with traditional SCP and those with modified ICP. Following surgery, one patient developed paraparesis, while two individuals with traditional SCP experienced persistent neurological damage. In patients with modified ICP, there were no postoperative neurological or other problems associated to atherosclerosis; nevertheless, one patient experienced stroke 5 months after surgery. Conclusion: Patients with shaggy aorta may not receive enough brain protection from TAR with standard SCP because single axillary artery perfusion can result in nonphysiological flow and atheroma separation. Even in patients with shaggy aortas, TAR with modified ICP is safe, but late-phase severe adverse cerebrovascular events should be taken into account.
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spelling pubmed-98160342023-01-12 Impact of the Isolated Cerebral Perfusion Technique for Aortic Arch Aneurysm Repair in Patients with a Shaggy Aorta Sugiyama, Kayo Watanuki, Hirotaka Tochii, Masato Futamura, Yasuhiro Ishizuka, Koki Matsuyama, Katsuhiko Ann Vasc Dis Original Article Objective: Total aortic arch replacement (TAR), particularly in individuals with extensive atherosclerotic alterations, especially shaggy aortas, is more crucial and difficult. The objective of this retrospective investigation was to ascertain if patients with shaggy aortas would respond to modified isolated cerebral perfusion (ICP). Materials and Methods: Between 2015 and 2020, nine individuals with shaggy aortas who received treatment for arch aneurysms were examined. Four and five patients, respectively, who had arch replacement with traditional selective cerebral perfusion (SCP) and modified ICP, were evaluated, and their short- and long-term results were compared. Results: There were no appreciable variations in the postoperative results between patients with traditional SCP and those with modified ICP. Following surgery, one patient developed paraparesis, while two individuals with traditional SCP experienced persistent neurological damage. In patients with modified ICP, there were no postoperative neurological or other problems associated to atherosclerosis; nevertheless, one patient experienced stroke 5 months after surgery. Conclusion: Patients with shaggy aorta may not receive enough brain protection from TAR with standard SCP because single axillary artery perfusion can result in nonphysiological flow and atheroma separation. Even in patients with shaggy aortas, TAR with modified ICP is safe, but late-phase severe adverse cerebrovascular events should be taken into account. Japanese College of Angiology / The Japanese Society for Vascular Surgery / Japanese Society of Phlebology 2022-12-25 /pmc/articles/PMC9816034/ /pubmed/36644259 http://dx.doi.org/10.3400/avd.oa.21-00128 Text en © 2022 The Editorial Committee of Annals of Vascular Diseases. https://creativecommons.org/licenses/by/2.5/This article is distributed under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided the credit of the original work, a link to the license, and indication of any change are properly given, and the original work is not used for commercial purposes. Remixed or transformed contributions must be distributed under the same license as the original.
spellingShingle Original Article
Sugiyama, Kayo
Watanuki, Hirotaka
Tochii, Masato
Futamura, Yasuhiro
Ishizuka, Koki
Matsuyama, Katsuhiko
Impact of the Isolated Cerebral Perfusion Technique for Aortic Arch Aneurysm Repair in Patients with a Shaggy Aorta
title Impact of the Isolated Cerebral Perfusion Technique for Aortic Arch Aneurysm Repair in Patients with a Shaggy Aorta
title_full Impact of the Isolated Cerebral Perfusion Technique for Aortic Arch Aneurysm Repair in Patients with a Shaggy Aorta
title_fullStr Impact of the Isolated Cerebral Perfusion Technique for Aortic Arch Aneurysm Repair in Patients with a Shaggy Aorta
title_full_unstemmed Impact of the Isolated Cerebral Perfusion Technique for Aortic Arch Aneurysm Repair in Patients with a Shaggy Aorta
title_short Impact of the Isolated Cerebral Perfusion Technique for Aortic Arch Aneurysm Repair in Patients with a Shaggy Aorta
title_sort impact of the isolated cerebral perfusion technique for aortic arch aneurysm repair in patients with a shaggy aorta
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9816034/
https://www.ncbi.nlm.nih.gov/pubmed/36644259
http://dx.doi.org/10.3400/avd.oa.21-00128
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