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Ruptured descending and thoracoabdominal aortic aneurysms
Leonard N Girardi1, Karl H Krieger, Nasser K Altorki
1Department of Cardiothoracic Surgery, Weill Medical College of Cornell University, New York, New York, USA. lngirard@mail.med.cornell.edu
The Annals of Thoracic Surgery
|October 29, 2002
Summary
Ruptured thoracic aneurysms can be repaired with a 17.5% mortality rate, but prompt diagnosis and treatment are crucial. Early repair of thoracic aortic aneurysms is recommended to prevent rupture and associated complications.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Elective repair of thoracic aortic aneurysms has improved outcomes.
- Ruptured thoracic aneurysms present unique challenges due to limited end-organ support.
- This study analyzes outcomes for ruptured thoracic aneurysms in the current era.
Purpose of the Study:
- To define the morbidity and mortality associated with ruptured thoracic aneurysms.
- To evaluate the effectiveness of current surgical techniques for ruptured thoracic aneurysms.
- To identify factors influencing outcomes in patients with ruptured thoracic aneurysms.
Main Methods:
- Retrospective analysis of 172 patients undergoing repair of thoracoabdominal or descending thoracic aortic aneurysms (July 1997-October 2001).
- Focus on 40 patients presenting with contained or free rupture.
- Surgical techniques included clamp and sew, left heart bypass, and hypothermic circulatory arrest, with adjuncts for support.
Main Results:
- Overall in-hospital mortality was 17.5% (7 of 40 patients), with 5 deaths in patients presenting in shock.
- Intraoperative deaths (4) were attributed to acute myocardial infarction.
- Complications included paraplegia (5%), renal failure (7.5%), tracheostomy (20%), recurrent nerve palsies (15%), and stroke (2.6%). Mean ruptured aneurysm diameter was 8.5 cm.
Conclusions:
- Ruptured thoracic aneurysms can be successfully repaired, emphasizing the need for rapid diagnosis and intervention.
- Shock at presentation significantly increases mortality.
- High incidence of myocardial infarction highlights the importance of cardiac evaluation for elective thoracic aneurysm repair and earlier referral for elective repair.