A Case of Thromboexclusion with Axillo-Bifemoral Bypass Grafting for Unresectable Abdominal Aortic Aneurysm.
10.4326/jjcvs.23.270
- VernacularTitle:切除不能腹部大動脈りゅうに対してえきか動脈‐両側大腿動脈バイパス併設ｔｈｒｏｍｂｏｅｘｃｌｕｓｉｏｎ法を施行して救命した１例
- Author:
Koichi Kino
;
Satoru Sugiyama
;
Mikizo Nakai
;
Akira Sugiyama
;
Kazuhiro Tsuji
;
Atsushi Tanabe
;
Sugato Nawa
;
Hatsuzo Uchida
;
Shigeru Teramoto
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
1994;23(4):270-275
- CountryJapan
- Language:Japanese
-
Abstract:
We performed the thromboexclusion procedure with reconstruction by an axillo-bifemoral bypass for unresectable abdominal aortic aneurysm combined with chronic renal faliure, and obtained satisfactory postoperative result. The patient was a 68-year-old male who suffered from a huge abdominal aortic aneurysm (AAA) and had a history of hypertension and chronic renal failure. The AAA was accompanied with a saccular portion 10cm in diameter which compressed and eroded the vertebral body. Aortic cross-clamping above the bilateral renal arteries was inevitable for resection in spite of the renal dysfunction. We decided that direct manipulation of the aneurysm was impossible despite it being on the verge of rupture, considering the high operative mortality. We employed the exclusion-bypass method to stabilize the aneurysm, that is, we constructed axillo-bifemoral bypass using a knitted Dacron T-graft 8mm in diameter and then intercepted the bilateral common iliac arteries by suture closure. Postoperative intraaneurysmal thrombosis progressed rapidly from the distal side, then it halted just below the bilateral renal arteries on the 12th postoperative day. Renal arterial flow was maintained and renal function improved. Bleeding from the operative wound occurred suddenly on the 5th postoperative day. Although this appeared to be disseminated intravascular coagulation initially, it had resulted from augmentation of fibrinolysis due do acceleration of coagulation. The markers of fibrinolysis for example α2 plasmin inhibitor (α2PI) and plasmin-α2 plasmin inhibitor complex (PIC) were useful for diagnosis, and tranexam acid and aprotinin were effective for therapy. Although the exclusion-bypass method is technically less invasive and useful for high-risk AAA, the postoperative management is not easy because of the acceleration of the coagulation-fibrinolysis system.
