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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.
Insights
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:
- 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.
Abstract:
Thoracoabdominal aortic reconstruction distal to the left subclavian artery was carried out on 19 patients between 1974 and 1990. Screening procedures to detect cardiac, respiratory or renal impairment were undertaken in all patients. Reconstruction was in the upper third of the descending aorta in 6 patients, middle third in 6 patients, and lower third in 7 patients. The Crawford inclusion technique was used in all cases. There were six deaths, four of which were from the high reconstruction group, and one each from the middle and lower group. Paraparesis occurred in 4 patients, 2 of whom survived with some impairment. Temporary renal failure was seen in 2 patients, liver failure in 2, respiratory failure in 2, sepsis in 1, myocardial infarction in 1, and severe coagulopathy in 3. The perioperative mortality rate was 32% for the group as a whole and 15% for reconstructions which started at the middle or lower thoracic level. We conclude that the mortality rate for the middle and lower reconstructions is acceptable but that alternative techniques for the high aneurysms should be sought.