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Evolving experience with thoracoabdominal aortic aneurysm repair at a single institution
M A Golden1, M C Donaldson, A D Whittemore
1Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
Journal of Vascular Surgery
|June 1, 1991
Summary
Improved surgical techniques significantly reduced mortality for thoracoabdominal aortic aneurysm repair. While operative mortality is now acceptably low, spinal cord ischemia remains a significant complication.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Aneurysm Repair
Background:
- Atherosclerotic thoracoabdominal aortic aneurysms (TAAA) pose significant surgical challenges.
- Historical surgical approaches were associated with high morbidity and mortality rates.
Purpose of the Study:
- To evaluate the impact of a standardized surgical technique on outcomes for TAAA repair.
- To compare outcomes between a historical technique and a modern, standardized approach.
Main Methods:
- Retrospective review of 57 patients undergoing TAAA repair between 1978 and 1990.
- Comparison of outcomes between two groups: pre-July 1987 (Group 1, n=19) and post-July 1987 (Group 2, n=38).
- Group 1: routine peritoneal entry, radial diaphragm division, no heparin. Group 2: standardized left thoracoabdominal incision, circumferential diaphragm division, extraperitoneal exposure, full heparinization, graft inclusion, visceral endarterectomy.
Main Results:
- Overall 30-day operative mortality was 18% (10 patients).
- Group 1 (older technique) had a 42% mortality rate and high rates of respiratory, renal failure, and myocardial infarction.
- Group 2 (standardized technique) showed a significantly reduced 30-day mortality of 5% and lower rates of myocardial infarction, respiratory failure, renal failure, and bleeding.
Conclusions:
- Modern, standardized surgical repair of thoracoabdominal aortic aneurysms yields acceptably low operative mortality rates.
- Spinal cord ischemia, leading to paraplegia and paraparesis, remains a critical and unresolved source of morbidity following TAAA repair.