Thoracoabdominal aneurysm resection after previous infrarenal abdominal aortic aneurysmectomy

Thoracoabdominal aneurysms in 51 patients were repaired over 5 years ending in February 1991. Fourteen (27%, 14 of 51) patients had a prior infrarenal aneurysm resection (PRA); their data are analyzed separately. The average age of patients who had undergone PRA was 67 years (range: 56 to 86 years). The mean aneurysm diameter was 8.6 cm (range: 5 to 12 cm), and the mean time interval between initial aneurysm surgery and subsequent resection of the thoracoabdominal aneurysm was 8.5 years (range: 2 to 17 years). Three patients in the PRA group were operated on emergently, two because of clinical evidence of rupture; the other patients underwent elective repair. Early mortality (30 days) in the PRA group was significantly related to age (72 years or older versus younger than 72 years: 75% versus 10%, p = 0.04), proximal extent of aneurysm (above diaphragm versus below diaphragm: 50% versus 0%, p = 0.05), ruptured aneurysm (ruptured versus nonruptured: 100% versus 16%, p = 0.06), and a cardiac history of myocardial infarction (57% versus 0%, p = 0.03), congestive heart failure (66% versus 0%, p = 0.01), or arrhythmia (80% versus 0%, p = 0.005). Similar results were seen with the entire group of patients with thoracoabdominal aneurysms except that the proximal extent of the aneurysm was not related to mortality. These results demonstrate that thoracoabdominal aneurysm resection after prior infrarenal aneurysmectomy is not associated with increased mortality or morbidity.