[en] This work presents the results of surgery in thoraco-abdominal aortic aneurysms (TAA) and thoracic descending aortic aneurysms (TDA) in one single center between January 1rst, 1996 and December 31, 2005. It concerns open surgery in 42 and endovascular procedures in ten patients. Forty two patients (11 TDA and 31 TAA (4 type I, 12 type II, 6 type III and 9 type IV)) define the open surgery series. Twenty six patients were operated on elective basis and 16 patients in emergency condition. Surgical correction was made under partial cardio-pulmonary bypass (PCPB) in 70% of cases via femoral vessels; most significant intercostal arteries were reimplanted and cerebro-spinal fluid (CSF) drainage used in half of the cases. Operative mortality was zero in the elective group (0/26) and attained 19% in the emergent group (3/16). Mortality was linked to cerebrovascular accidents (CVA) in two cases and post-pump left lung hemorrhagic intarction in one case. The paraplegia accounts 2/26 in the elective group and one in the emergent group (1/16). That is 7.1% in both groups. At the end of five years, survival is 66% in elective group and 74% in the emergency group. Ten patients (5 TDA and 5 TAA (2 type I, 3 type III)) were treated endovascularly. Operative mortality and postoperative paraplegia were nil.
Disciplines :
Cardiovascular & respiratory systems Surgery
Author, co-author :
El Arid, J.-M.
CREEMERS, Etienne ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie cardio-vasculaire
Limet, Raymond ; Université de Liège - ULiège > Département des sciences cliniques > Chirurgie cardio-vasculaire et thoracique
Language :
English
Title :
Surgical treatment of thoraco-abdominal and low thoracic aneurysms of the aorta. One single center experience over ten years
CAMBRIA R., DAVISON J., ZANNETTI S., L'ITALIEN G., ATAMIAN S. Thoracoabdominal aneurysm repair: perspectives over a decade with the clamp-and-sew technique. Ann Surg, 1997, 226: 294-305.
CINA C. S., LAGANA A., BRUIN G., RICCI C., DOOBAY B., TITTLEY J., CLASE C. M. Traitement Chirurgical des Anévrysmes de l'Aorte Thoraco-abdominale: Etude Prospective d'une Cohorte de 121 Malades. Ann Chir Vasc, 2002, 16: 631-638.
CRAWFORD E. S., CRAWFORD J. L., SAFI H. J., HESS K. R., BROOKS B. et al. Thoracoabdominal aortic aneurysms: Preoperative and intraoperative factors determining immediate and long term results of operations in 605 patients. J Vasc Surg, 1986, 3: 389-404.
MITCHEL R. S., MILLER D. C., DAKE M. D., SEMBA C. P., MOORE K. A., SAKAI T. Thoracic aortic aneurysm repair with an endovascular stent graft: «the first generation». Ann Thorac Surg, 1999, 67: 1971-4.
PIRARD L., CREEMERS E., VAN DAMME H., LAURENT S., HONORÉ P., LIMET R. In situ aortic allograft insertion to repair a primary aortoesophageal fistula due to thoracic aortic aneurysm. J Vasc Surg, 2005, 42: 1213-7.
FRANK S. M., PARKER S. D., ROCK P. et coll. Moderate hypothermia, with partial bypass and segmental sequential repair for thoracoabdominal aortic aneurysm. J Vasc Surg, 1994, 19: 687-697.
GOLDEN M. A., DONALDSON M. C., WHITTEMORE A. D., MANNICK J. A. Evolving experience with thoracoabdominal aortic aneurysm repair in a single institution. J Vasc Surg, 1991, 13: 792-797.
KOUCHOUKOS N., MASETTI P., ROKKAS C., MURPHY S. Hypothermic cardiopulmonary bypass and circulatory arrest for operations on the descending thoracic and thoracoabdominal aorta. Ann Thorac Surg, 2002, 74: 1885-7.
VELASQUEZ O. C., BAVARIA J. E., POCHETTINO A., CARPENTER J. P. Emergency repair of thoracoabdominal aneurysm with immediate presentation. J Vasc Surg, 1999, 30: 996-1010.
GRABITZ K., SANDMANN W., STUHEIMIER K., MAINZER B., GODEHARDT E., OHLE B. et al. The risk of ischemic spinal cord injury in patients undergoing graft replacement for thoracoabdominal aortic aneurysms. J Vasc Surg, 1996, 23: 306-40.
LEMAIRE S. A., RICE D., SCHMITTLING Z. C., COSELLI J. S. Emergency surgery for thoracoabdominal aortic aneurysms with acute presentation. J Vasc Surg, 2002, 35: 1171-8.
QUINONES-BALDRICH W. J. Traitement des Anévrysmes de l'Aorte Thoracique Descendante et Thoracoabdominale: Résultats d'une approche uniforme au cours d'une période de 15 ans. Ann Chir Vasc, 2004, 18: 335-342.
ENGLE J., SAFI H. J., MILLER C. C. III. The impact of diaphragm management on prolonged ventilatory support after thoracoabdominal aortic repair. J Vasc Surg, 1999, 29: 150-156.
SVENSSON L. G., CRAWFORD E. S., HESS K. R. et coll. Thoracoabdominal aortic aneurysm associated with celiac, superior mesenteric, and renal artery occlusive disease: methods and analysis of results in 271 patients. J Vasc Surg, 1992, 16: 378-390.
OREND K.H., SCHARRER-PALMER R., KAPFER X., KOTSIS T., GORICH J., SUNDER- PLASSMAN L. Endovascular treatment in diseases of the descending thoracic aorta: 6-year results of a single center. J Vasc Surg, 2003, 37: 91-9.
SONG T., DONAYRE C., WALOT I., KOPCHOC G., LITWINSKI R., LIPPMANN M., SARKISYAN G., OMARI B., WHITE R. Endograft exclusion of acute and chronic descending thoracic aortic dissections. J Vasc Surg, 2006, 43: 247-58.