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首页> 外文期刊>Perfusion >Continuous selective bilateral antegrade cerebral perfusion through anomalous innominate artery for repair of root, ascending aortic and arch aneurysm--challenges, vagaries and opportunities of bovine arch variant anatomy and review of literature.
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Continuous selective bilateral antegrade cerebral perfusion through anomalous innominate artery for repair of root, ascending aortic and arch aneurysm--challenges, vagaries and opportunities of bovine arch variant anatomy and review of literature.

机译：通过畸形的无名动脉连续选择性进行双侧顺行性脑灌注以修复根，升主动脉和弓状动脉瘤-牛弓变体解剖学的挑战，变幻莫测和机会并进行文献复习。

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We describe the repair of a root, ascending aortic and arch aneurysm in a 69-year-old man with a bioprosthetic Shelhigh conduit and cylinder, employing continuous bilateral antegrade cerebral perfusion through an anomalous innominate artery with a bovine arch variant anatomy. The origin of both the innominate artery and the left common carotid artery from a common stem from the arch in this bovine arch variant puts the whole cerebral circulation at risk, on one hand, yet provides an opportunity of continuous bilateral antegrade cerebral perfusion through the right brachial, right axillary, right subclavian or innominate artery, during arch reconstruction under lower body, deep hypothermic circulatory arrest. Safety and adequacy of selective cerebral perfusion through the right axillary artery in patients with normal arch vessel origin depends on an intact circle of Willis. In this bovine arch variant, both cerebral hemispheres can be perfused through the right brachial, right axillary, right subclavian or the innominate artery, independent of the integrity of the circle of Willis, because of the origin of the left common carotid artery from the innominate artery, except for the area supplied by the left vertebral artery. Although this is the first report of innominate artery perfusion for arch reconstruction for aneurysm in a bovine arch variant, we believe the method described has important implications for cerebral protection in light of the generally reported incidence of bovine arch from 13 to 35 percent.
机译：我们描述了一个69岁的男子，用生物修复的谢尔海德导管和圆柱修复根，升主动脉和弓状动脉瘤，通过牛的无名动脉进行连续的双侧顺行脑灌注，并进行了牛弓变体解剖。在这种牛弓变体中，无名动脉和左颈总动脉的起源均来自弓的共同茎，一方面使整个脑循环处于危险之中，但另一方面却提供了通过右侧连续进行双侧顺行性脑灌注的机会。肱骨，右腋窝，右锁骨下或无名动脉，在下半身下的足弓重建期间，深部低温循环停止。对于具有正常弓形血管起源的患者，通过右腋动脉进行选择性脑灌注的安全性和充分性取决于完整的Willis圆。在这种牛弓变体中，由于左颈总动脉起源于无名指，因此可以通过右臂，右腋，右锁骨下或无名动脉灌注两个脑半球，而与Willis环的完整性无关。除左椎动脉供血区域外尽管这是关于牛弓变体中动脉瘤弓重建的无偿动脉灌注的首次报道，但鉴于一般报道的牛弓发生率从13％到35％，我们认为上述方法对脑保护具有重要意义。

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