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Thoracoabdominal aortic aneurysm reconstruction.

R S Lord1, C B Reid, A R Graham

  • 1Surgical Professional Unit, St. Vincent's Hospital, University of New South Wales, Sydney, Australia.

The Journal of Cardiovascular Surgery
|September 1, 1991
PubMed
Summary
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Thoracoabdominal aortic reconstruction using the Crawford technique showed a 32% mortality rate. High thoracic reconstructions had higher mortality, suggesting alternative methods are needed for these complex aortic aneurysms.

Area of Science:

  • Vascular Surgery
  • Cardiovascular Research

Background:

  • Thoracoabdominal aortic aneurysms require complex surgical reconstruction.
  • The Crawford inclusion technique is a standard method for these repairs.

Purpose of the Study:

  • To evaluate the outcomes of thoracoabdominal aortic reconstruction distal to the left subclavian artery.
  • To assess the safety and efficacy of the Crawford inclusion technique in different aortic segments.

Main Methods:

  • Retrospective analysis of 19 patients undergoing thoracoabdominal aortic reconstruction between 1974 and 1990.
  • Utilized the Crawford inclusion technique for all cases.
  • Screening for cardiac, respiratory, and renal impairment was performed preoperatively.

Main Results:

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  • Overall perioperative mortality was 32%.
  • Mortality was significantly higher in the upper third descending aorta reconstructions (4/6 deaths) compared to middle (1/6) and lower (1/7) thirds.
  • Complications included paraparesis (4 patients), renal failure (2), liver failure (2), respiratory failure (2), sepsis (1), myocardial infarction (1), and coagulopathy (3).
  • Mortality for middle and lower thoracic level reconstructions was 15%.

Conclusions:

  • Thoracoabdominal aortic reconstruction in the middle and lower thoracic levels using the Crawford technique is associated with an acceptable mortality rate.
  • Alternative surgical strategies should be explored for high thoracoabdominal aortic aneurysms due to increased mortality.