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Emergency surgery for thoracoabdominal aortic aneurysms with acute presentation
Scott A LeMaire1, David C Rice, Zachary C Schmittling
1Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
Journal of Vascular Surgery
|June 4, 2002
Summary
Emergency repair of thoracoabdominal aortic aneurysms has higher mortality than elective surgery. However, specialized centers can achieve reasonable outcomes, especially with surgical adjuncts, regardless of patient age.
Area of Science:
- Cardiovascular Surgery
- Aortic Aneurysm Repair
- Thoracoabdominal Aortic Aneurysm (TAAA)
Background:
- Elective repair of thoracoabdominal aortic aneurysms (TAAA) has low mortality (4%) in experienced centers.
- Emergent TAAA presentation (rupture, dissection) traditionally carries a poor prognosis.
Purpose of the Study:
- Evaluate surgical outcomes for acute TAAA presentation at a specialized tertiary referral center.
- Compare outcomes between acute and elective TAAA repair.
Main Methods:
- Retrospective analysis of 1220 TAAA repairs (1986-1998).
- 112 patients had acute presentation; 1108 had elective repair.
- Data collected prospectively in a dedicated database.
Main Results:
- Operative mortality was 17% for acute TAAA vs. 6% for elective (P=.0004).
- Acute TAAA had higher rates of pulmonary complications (45%), paraplegia (14%), and renal impairment (25%).
- Surgical adjuncts (left heart bypass, reattachment of intercostal arteries) improved outcomes in acute cases.
Conclusions:
- Acute TAAA repair is associated with worse outcomes than elective repair.
- Specialized centers can achieve reasonable mortality/morbidity for acute TAAA.
- Surgical adjuncts are crucial for improving outcomes in acute TAAA repair.
- Age is not a limiting factor for TAAA repair in acute cases.