抄録
Background: In cases of infectious thoracic aortic aneurysm (TAA), in which the omentum is unavailable, the aortic graft can be wrapped in a latissimus dorsi (LD) flap. However, it remains unclear which intrathoracic approach is best for LD flap application. We measured the intrathoracic approach in cadavers and assessed its outcomes in clinical cases.
Methods: In 20 cadavers, the distances between the origin of the left subclavian artery and the intersections of the second, third, and fourth intercostal spaces (ICSs) with the posterior axillary line were measured. Adequate approaches were used in five patients with infectious TAA who were followed up for 4–57 months.
Results: In cadavers, passing the LD flap through the second ICS dorsally enabled adequate wrapping of the total descending aorta. Passing the LD flap through the fifth to seventh ICSs enabled thorough wrapping of the distal descending aorta. The distance between the origin of the left subclavian artery and the intersection of the second ICS and posterior axillary line was shorter than that between the origin and intersections of the third or fourth ICSs and the line. Clinically, these approaches achieve a full-circumference wrapping closure. The infection was well-controlled, with no anastomotic failures.
Conclusions: The graft can be circumferentially wrapped when the LD flap is passed through the second ICS for the total descending aorta and through the fifth to seventh ICSs for the distal descending aorta. LD flaps may be a good alternative when the omentum is not available.
