A Case of Aortic Replacement for a Patient with Bilateral Internal Carotid Stenoses
10.4326/jjcvs.32.307
- VernacularTitle:両側内頚動脈狭窄を伴った遠位弓部大動脈りゅうに対し上行および弓部大動脈置換術を施行した１例
- Author:
Akira Yamazaki
;
Shigeyuki Aomi
;
Masaki Nonoyama
;
Hideyuki Tomioka
;
Kenji Yamazaki
;
Akihiko Kawai
;
Hiroshi Nishida
;
Masahiro Endo
;
Hiromi Kurosawa
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
2003;32(5):307-310
- CountryJapan
- Language:Japanese
-
Abstract:
A 71-year-old man was given a diagnosis of saccular aneurysm of the aortic arch (maximum 48mm in diameter) at the age of 68. When he was 69 years old, he began to take steroids for autoimmune hepatitis (AIH). The following year, the aneurysm was enlarged to 52mm. Further examinations showed the aneurysm to extend to the ostium of the left subclavian artery. Since he had transient ischemic attacks, ultrasonography of the carotid arteries was performed. Bilateral internal carotid stenoses were detected, however, cold Xe CT showed an almost normal pattern of cerebral blood flow. We decided that operation was feasible using retrograde cerebral perfusion (RCP). Liver dysfunction due to AIH improved, and his steroid dosage was tapered. Using RCP, the no-touch technique and the elephant trunk procedure, he underwent the replacement of ascending aorta and aortic arch and was discharged without major complications. RCP and the no-touch technique might enable safer operations on patients with carotid stenoses.
