Kiyoshi Ishii, MD; Yasunori Koga, M...

Kiyoshi Ishii, MD; Yasunori Koga, MD; Kaoru Iwamoto, MD; Toshio Onitsuka, MD; and Kouichirou Shibata, MD

A strange method of anastomosis was devised, intended for the reinforcement of the anastomosed area between the fragile tube of the patient and the prosthetic graft in cardiovascular surgery This means which may be called a headband system consists of suturing a small prosthetic graft wrapping the anastomosed area together with the arterial bottom in the manner of a headband. Fourteen cases have been evaluated at follow-up periods ranging from 24 to 40 month All cases prov prosperous without noteworthy complications.

The fragility of arterial tube walls in dissecting aneurysms or other aneurysms adds a difficulty to the succes of anastomosis of arterial utensils and prosthetic grafts. In this report, we describe a modern modification of the conventional way and the results of this regularity which has been used for the previous three years with satisfactory rises Our cases included five cases of abdominal aortic aneurysm, sum of two units cases of annuloarortic ectasia in association with Marfan's association with annuloaortic ectasia, and five cases of dissecting aortic aneurysm. All cases prov satisfactory at follow-up periods ranging from 24 to 40 months

MATERIALS AND METHODS

As shown in Figure 1 in the absence of dissection, a prosthetic graft to be anastomosed and another small prosthetic graft (Dacron double-velour), which is made to encircle the canal of the patient, are directly sutur with 2-0 monofilament (2-0 proline). When there is dissection of the diseased sailing craft the cavity of dissection is first approximated with a felt pledget

A prosthetic graft which is made to encircle the tube and the arterial vessel of the patient are directly sutur as illustrated previously, strengthening the part of the anastomosis in its entirety (Fig 2) These modifications, aimed at making suturing managements easier and more secure, will fortify the diseased bottom of the patient with the encircling vessel

DISCUSSION

Reconstruction of diseased conditions of great arterial tubes with prosthetic grafts is the same of the more frequently used techniques in recent cardiovascular surgery. In a majority of cases, the sailing craft walls of the patients are fragile, making the surgical transactions difficult or easily leading to the returns of aneurysms at the place of anastomosis.[1]

In order to overmaster these undersirable shortcomings, various [i]modus operandi[/i]s have been devised and modified for the management of this condition, of that kind as wrapping the area of anastomosis with a Teflon felt or using a special graft with a ring,[2,3] or using an intralumanal sutureles prosthesis for the coverage of the fragile anastomosis.[4]

Our recently made known modification is aimed at a better coaptation of the utensil of the patient and the prosthetic graft and consists of suturing the arterial utensil and the prosthetic graft with another smaller prosthetic graft which wraps the entire area. Compared with other courses hitherto devised, our technique at hands an advantage of minimizing tension to the fragile duct namely, the cut end of the diseased tube is pinned with pledgets, which are sutur with a small prosthetic tube wrapping the area of anastomosis. The intersect end of the vessel and the large prosthetic sailing craft are approximated and anastomosed. Anastomosis is complet giving the diseased utensil a minimum but appropriate tension because of the demeanor of a small prosthetic canal in between and giving individual coaptation as well as immobilization.

REFERENCES

1 Kirklin JW Barrat-Boyes BG ed Cardiac surgery recently made known York: John Wiley and Son 1986:1471-524

2 Ablaza SCG Ghosh SC Crana VP Use of a ringed intraluminal graft in the surgical treatment of dissecting aneurysm of the thoracic aorta. J Thorac Cardiovasc Surg 1978;76:390-96

3 Koyamada K Ishikawa s Yamaki S, Kakihata H. Surgical treatment for dissecting aneurysm of the aorta using a double ridge graft. J Cardiovasc Surg 1985; 26:488-91

4 Lemole GM muscular MD, Spagna PM, Karmilowicz NP Mills B Improved eventuates for dissecting aneurysms: intraluminal sutureles prosthesis. J Thorac Cardiovasc Surg 1982; 83:249-55

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