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. 2009;1(1):45-53.

Management of thoracoabdominal aortic aneurysms

R Chiesa  1 , E Civilini, G Melissano, D Logaldo, F M Calliari, L Bertoglio, A Carozzo, R Mennella
Affiliations

Management of thoracoabdominal aortic aneurysms

R Chiesa et al. HSR Proc Intensive Care Cardiovasc Anesth. 2009.

Abstract

Conventional treatment of thoracoabdominal aortic aneurysms (TAAAs) consists of graft replacement with reattachment of the main aortic branches. Over the past 20 years a multimodal approach has gradually evolved to reduce the trauma of surgery by maximizing organ protection, allowing experienced surgical Centers to have better outcomes than previously reported. However, mortality and morbidity associated to TAAA open repair remain significant. Hybrid repair, consisting of open aortic debranching and revascularization followed by endovascular exclusion of the aneurysm, may extend the indications of TAAA repair to high-risk patients that cannot benefit from surgery, however results are still under evaluation. Aim of this paper is to illustrate the management and results of thoracoabdominal aortic aneurysms surgery with open techniques of organ protection and hybrid approach in our Center.

Keywords: Anesthesia; Surgery; Thoracoabdominal aortic aneurysms; Vascular surgery.

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Conflict of interest statement

Conflict of interest No conflict of interest acknowledged by the authors

Figures

Figure 1
Figure 1
Type II thoracoabdominal aortic aneurysm exposure through thoraco-phrenolaparotomy.
Figure 2
Figure 2
Left heart bypass and renal perfusion catheters.
Figure 3
Figure 3
Transection of the thoracic aorta and end-to-end anastomosis. Ligature of segmental arteries is also shown.
Figure 4
Figure 4
Type II TAAA repair: aortic graft replacement and visceral vessels reattachment by means of Carrel patch (left) and Coselli thoracoabdominal graft (above).
Figure 5
Figure 5
The Vascutek Triplex™ graft consists of three layers: an inner polyester graft, an outer ePTFE layer and a central layer of elastomeric membrane.
Figure 6
Figure 6
Preoperative CT of a patient with type III TAAA (left). The hybrid procedure consisted of infrarenal aortic grafting with single visceral vessels revascularization (center). Control angioCT demonstrated TAAA excusion and visceral bypasses patency (right).
Table 1
Table 1
Morbidity and mortality after TAAA conventional repair in high-volume Centers.
Table 2
Table 2
Results after TAAA conventional repair - Università Vita-Salute, Scientific Institute San Raffaele, Milan, Italy.
Figure 7
Figure 7
Graphs show in-hospital mortality rates in function of annual hospital volume (left) and annual surgeon volume (right).
Table 3
Table 3
Morbidity and mortality after TAAA hybrid repair in the main series in literature.
Figure 8
Figure 8
Graphs show the impact of paraplegia/ paraparesis on survival of patients who underwent surgical or endovascular TAAA repair (SCI: spinal cord ischemia; SCID: spinal cord ischemia deficit; SCID I: flaccid paralysis; SCID II: muscle function <50%; SCID III: muscle function >50%)
See this image and copyright information in PMC

References

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