Prosthetic bypass and flow reversal in the dissecting thoraco-abdominal aortic aneurysm

In 1981 Carpentier and Co-workers introduced an alternative surgical procedure for great dissecting thoraco-abdominal aortic aneurysms, departing from the resection and the orthotopic implantation of a prosthesis (graft inclusion technique). Compression of the aneurysmatic false lumen from the inside under stepwise thrombosis of the aneurysmal sac with conservation of the main arterial origins was achieved by prosthetic bypass of the diseased vascular part and a flow reversal in the dissected aortic region by an oblique suture across the aortic lumen after the origin of the left subclavian artery. This procedure, distinguished by rather little effort and few complications (bleeding, ischaemic spinal cord damage) is described for all stages of dissecting thoracal aortic aneurysms. In the last 2 years this operation was performed in our department on 4 patients (1 m. 3 f) suffering from an acute dissecting thoraco-abdominal aortic aneurysm (Stanford type B). 2 patients died in the early postoperative period, one from a redissection close to the proximal anastomosis, the other due to the critical cardiac situation. 2 patients could be followed up postoperatively 10 and 27 months. In both cases no signs of minor perfusion of the spinal cord, the kidneys, or the mesenterial organs were observed. In both cases a partial thrombosis of the aneurysmal sac with intact blood stream to the major vessels in these regions could be demonstrated by sonography, angiography or DSA, and computer tomography. The concept of flow reversal proved to be an alternative to major resection procedures.