| 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 |
Related Documents
:
|
19683986 - Favorable early outcomes for patients with extended indications for thoracic endografting. 15649716 - Management of thoracoabdominal aneurysm type iv. 8053516 - Risk of respiratory failure after repair of thoracoabdominal aortic aneurysms. 21858106 - Impaired vascular contractility and aortic wall degeneration in fibulin-4 deficient mic... 17505446 - A surgical case of pulmonary adenocarcinoma complicated with pulmonary infarction prese... 12427626 - Mycotic aneurysms as lethal complication of brain pseudallescheriasis in a near-drowned... |
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 |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| 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
Previous Document: Expanding options for bedside placement of inferior vena cava filters with intravascular ultrasound ...
Next Document: Prevention of postischemic spinal cord injury by means of regional infusion of adenosine and L-carni...