Document Detail


Descending thoracic and thoracoabdominal aortic aneurysm repair: 15-year results using a uniform approach.
MedLine Citation:
PMID:  15354636     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This review presents the results of surgical repair of descending thoracic (DT) and thoracoabdominal aortic (TAA) aneurysms, using spinal drainage (SD) distal aortic perfusion (DAP), and other adjuncts intended to reduce complications. Records of patients undergoing repair of DT and TAA between 1986 and 2002 were reviewed. Elective operations were performed using single lung ventilation, invasive monitoring, SD, modest anticoagulation, permissive hypothermia (> or = 33 degrees F), liberal use of transaortic endarterectomy, and complete repair. Intercostal arteries were reimplanted when possible and DAP was used in DT and TAA types I, II, and III repair. Exceptions to this approach were noted. Some of these adjuncts were used in emergency cases. Actuarial survival was calculated. Fifty consecutive patients with DT (3) or TAA (47), type I (4), type II (16), type III (18), or type IV (9), aneurysms received elective (36) or emergency (14) repair between 1986 and 2002. Mortality was 2/36 (5.5%) in the elective group. In the emergency group, there were 2 intraoperative deaths and mortality was 4/14 (28.5%, p < 0.07). Overall survivor morbidity was 6/34 (17.6%) in elective and 7/10 (70%, p < 0.02) in emergency cases. Paraplegia occurred in one patient in the elective group (2.7%) with dissecting type II TAA aneurysm in whom the intercostal patch was sacrificed. Two of 12 initial survivors developed paraplegia in the emergency group (16.7%); one had SD but neither had DAP or intercostal reimplantation. Serious complications were associated with avoidable deviations from the approach. Five and 10-year survival for the entire series was 64.8% and 46.4%, respectively. These results parallel those in contemporary reports from centers where repair of descending and thoracoabdominal aortic aneurysm is frequently performed. Good long-term results can be achieved using spinal drainage and distal aortic perfusion, combined with other adjuncts as a means of reducing complications. When possible, the same approach should be used in emergency cases.
Authors:
William J Quinones-Baldrich
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Annals of vascular surgery     Volume:  18     ISSN:  0890-5096     ISO Abbreviation:  Ann Vasc Surg     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-09-09     Completed Date:  2004-11-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  335-42     Citation Subset:  IM    
Affiliation:
Department of Surgery, Division of Vascular Surgery, University of California, Los Angeles, Los Angeles, CA 90095, USA. wquinones@mednet.ucla.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aneurysm, Dissecting / classification,  epidemiology,  surgery
Aortic Aneurysm, Abdominal / classification,  epidemiology,  surgery*
Aortic Aneurysm, Thoracic / classification,  epidemiology,  surgery*
Aortic Rupture / classification,  epidemiology,  surgery
Drainage
Emergency Medical Services
Female
Femoral Artery / pathology,  surgery
Humans
Iliac Aneurysm / classification,  epidemiology,  surgery
Los Angeles / epidemiology
Male
Middle Aged
Morbidity
Postoperative Complications / etiology,  mortality
Reoperation
Retrospective Studies
Survival Analysis
Treatment Outcome
Vascular Surgical Procedures*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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