Pseudo-aortic aneurysm resection

Part of the aortic wall ruptured during trauma, and a localized hematoma was formed due to the surrounding soft tissue surrounding it, accompanied by pulsation, called pseudoaneurysm. And because the aortic adventitia is relatively tough, it can withstand 60% of the aortic pressure, so the local formation of hematoma, can survive in a short time. About 20% of the wounded can survive to hospital, and 80% of those who have not had surgery have died of fatal bleeding immediately or within 3 weeks. According to the history of trauma, chest pain, shortness of breath and widening of the mediastinal shadow under fluoroscopy, it is generally not difficult to make a diagnosis. Pseudo aortic aneurysms occur mostly in the isthmus, but it is difficult to presuppose the extent of aortic injury, and it has been reported that when the aorta around the aortic intima of the aorta forms a dissecting aneurysm, it can spread to the proximal and distal ends, thus Will increase the length and difficulty of the aortic resection segment. Must be noted. Treatment of diseases: pseudoaneurysms Indication Once a suspected pseudo-aortic aneurysm is diagnosed, surgical exploration should be performed as soon as possible to remove the tumor wall and repair the aortic wall defect. It is currently believed that the use of endoluminal stent grafts for the treatment of such pseudoaneurysms not only simplifies the operation but is also safer and more effective. Preoperative preparation 1. Surgery should be performed under cardiopulmonary bypass or left heart bypass. 2. Prepare artificial blood vessels of different calibers or the same kind of aorta stored at low temperature. 3. During the preparation of the operation, it is necessary to pay attention to control blood pressure, so that the systolic blood pressure is reduced to about 100 mmHg, which can delay the increase of the pseudoaneurysm and help prevent sudden rupture. Surgical procedure 1. The descending aortic aneurysm should be performed under left heart bypass. Before performing any operation in the injured area, the proximal and distal aorta lesions must be bypassed with a spare obstruction band. The operation should be light when separated, often between the left common carotid artery and the origin of the left subclavian artery. The proximal end is controlled, and the proximal left subclavian artery is blocked. In the separation of the aortic arch should be along the outer wall of the aorta, pay attention to avoid its surrounding structures, including pulmonary artery, vagus nerve and recurrent laryngeal nerve injury, the distal end should be close to the injury area, as much as possible to retain more intercostal blood flow. The artificial blood vessel is selected in advance, generally 16 to 20 mm, and the blood vessel suture is mostly 4-0 polypropylene thread. 2. After the left heart bypass is established, the proximal aortic obstruction forceps can be placed between the left common carotid artery and the left subclavian artery, or close to the origin of the left subclavian artery, and clamp the distal descending aorta. 3. Longitudinal incision of the hematoma, to find out the extent of the injury, usually found that the middle and intima are completely transected, there are several centimeters of fissure between the proximal and distal ends, trimming the residual wall, retaining the intercostal blood vessels as much as possible, if possible The distal obstruction forceps are slightly displaced proximally. 4. The aortic wall has a small rupture, and it can be directly and continuously anastomosed to ensure the intima to the intima. 5. When the blood vessel is completely broken, artificial blood vessel transplantation should be done. Free the upper and lower aortic wall, trim the gap, usually need to insert a section of 3 ~ 4cm long artificial blood vessels. First, the proximal end of the anastomosis, simple suture, the anastomosis is completed, the test does not leak blood, and then the distal anastomosis. 6. Open the lower end and the subclavian artery obstruction forceps to eliminate gas accumulation in the artificial blood vessel cavity, and then slowly loosen the upper end obstruction forceps to reconstruct the descending aortic blood flow. After opening the blood flow of the descending aorta, if a leak is found, immediately use a sputum suture to suspend the bleeding. 7. Stop left heart bypass, clear the surgical field blood, completely stop bleeding, remove the left heart bypass cannula, place the closed thoracic drainage tube, and close the chest as usual.