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Emergency repair of thoracoabdominal aortic aneurysms with immediate presentation
O C Velazquez1, J E Bavaria, A Pochettino
1Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
Objective:
The objective of this report was the study of the clinical outcome of emergently repaired thoracoabdominal aortic aneurysms (TAAAs).
Methods:
We retrospectively reviewed our experience with TAAA repairs from 1990 to 1998. During this interval, 110 TAAA procedures were performed, 33 (30%) of which were for immediate presentations. The chi(2) test and regression analysis were used for the analysis of mortality, paraplegia, and renal failure (hemodialysis) rates and of factors that predict these complications, respectively.
Results:
There were no significant differences between the elective and immediate presentations with respect to the use of adjunctive procedures (lumbar drain, hypothermia, and bypass grafting). The overall mortality rate was 13%. There were no statistically significant differences between the 30-day mortality rates or the complication rates in elective versus immediate presentations. Subgroup analysis results showed a significantly higher in-hospital mortality rate in type II TAAA with immediate presentation and free rupture presentation as compared with the overall mortality rate (50% vs 13%, P <.05, and 67% vs 13%, P <.01, respectively). Multiple regression analysis results identified the use of bypass grafting (atrial-femoral or cardiopulmonary) and lumbar drain and shorter bypass grafting time as significant predictors of decreased overall mortality (P <.05). The mortality rates were not significantly different among aneurysm types and were not significantly decreased with the use of hypothermia. Paraplegia (5%) and renal failure (9%) rates were not predicted with aneurysm type, immediate versus elective presentation, or the adjunctive use of hypothermia, lumbar drain, or bypass grafting.
Conclusion:
The emergency repair of TAAA with immediate presentation can be performed with mortality and morbidity rates that approach those of elective presentations, except in the setting of free rupture or symptomatic type II TAAA. Adjunctive circulatory management techniques and lumbar drains may reduce mortality in TAAA repair.