Current Open Treatment of Thoracoabdominal Aortic Aneurysms
Thoracoabdominal aortic aneurysms (TAAAs) are permanent localized dilations of the aorta that involve the celiac axis and extend proximally or distally from this point. The development and use of multimodal protective adjuncts in specialized surgical cent
- PDF / 3,778,005 Bytes
- 15 Pages / 504.567 x 720 pts Page_size
- 63 Downloads / 257 Views
77
Maral Ouzounian, Scott A. LeMaire, Scott A. Weldon, and Joseph S. Coselli
77.1 Procedure Open surgical repair remains the gold standard operation for thoracoabdominal aortic aneurysms (TAAAs), which involve both the descending thoracic and abdominal aortic segments. These aneurysms can be caused by aortic dissection or by progressive medial degeneration without dissection. Contemporary surgical approaches balance the need to maximize longterm benefit by replacing as much diseased aorta as possible with limiting ischemia-related risk to the spinal cord and other organs. Despite the formidable challenges that extensive aortic replacement entails, early and late outcomes after these operations are excellent. In a recent series of 3309 open TAAA repairs [1], we observed an early mortality rate of 7.5% and low rates of persistent paraplegia or paraparesis (5.4%), stroke M. Ouzounian Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, ON, CA e-mail: [email protected] S. A. LeMaire (*) · S. A. Weldon · J. S. Coselli Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA Department of Cardiovascular Surgery, The Texas Heart Institute, CHI Baylor St Luke’s Medical Center, Houston, TX, USA e-mail: [email protected]; [email protected]; [email protected]
(2.2%), and renal failure necessitating permanent dialysis (5.7%). The most extensive operations—Crawford extent II repairs—involve replacing the entire descending thoracic and abdominal aorta. In this chapter, we describe the procedure for performing a Crawford extent II repair in detail, and we mention some alternative scenarios that a surgeon may encounter.
77.2 Indications and Contraindications Surgical repair of the thoracoabdominal aorta is ideally done electively to prevent a catastrophic event, such as rupture of the aorta (Fig. 77.1). For asymptomatic patients, we generally recommend TAAA repair when the aneurysm diameter exceeds 6.0 cm or has expanded by more than 0.5 cm in 1 year [2]. Patients who develop symptoms related to a TAAA undergo surgical repair regardless of aneurysm diameter. The most common indication for urgent repair of a TAAA is superimposed acute dissection. We recommend earlier intervention at a threshold of 5.5 cm in those with a confirmed genetic etiology of their aortic disease or chronic aortic dissection. Other urgent indications include aortic rupture and any symptom or sign indicating a high risk of rupture: refractory pain, refractory hypertension, or rapid aortic expansion. Acute dissection of the thoracoabdominal aorta may also lead to malperfusion of vital organs and limbs, necessitating restora-
© Springer-Verlag GmbH Austria, part of Springer Nature 2019 O. H. Stanger et al. (eds.), Surgical Management of Aortic Pathology, https://doi.org/10.1007/978-3-7091-4874-7_77
1075
M. Ouzounian et al.
1076
for stenotic origins, their spatial relationships to each other, and whether the true l
Data Loading...
