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Surgery of thoracoabdominal aneurysms
R Pokela1, M Tarkka, M Lepojärvi
1Department of Surgery, Oulu University Central Hospital, Finland.
Summary
This study on thoracoabdominal aneurysms shows that surgical repair using a diaphragm-splitting incision with protective measures like shunts or cold perfusion is effective. The procedure resulted in good long-term survival and graft patency with minimal complications.
Area of Science:
- Vascular Surgery
- Thoracoabdominal Aneurysm Repair
Background:
- Thoracoabdominal aneurysms pose significant surgical challenges.
- High morbidity and mortality rates are associated with traditional repair methods.
Purpose of the Study:
- To evaluate the safety and efficacy of a specific surgical technique for thoracoabdominal aneurysms.
- To assess perioperative ischemia protection strategies and long-term outcomes.
Main Methods:
- Seventeen patients underwent repair using a left diaphragm-splitting thoracoabdominal incision and retroperitoneal approach.
- Protective measures included temporary shunts (13 patients), femorofemoral perfusion (1 patient), or cold kidney perfusion (3 patients).
- A step-by-step graft reattachment technique was employed to minimize ischemic times.
Main Results:
- Mean renal and proximal clamping times were 44 and 77 minutes, respectively.
- One perioperative death (6%) occurred in a ruptured aneurysm case; no paraplegia or severe renal complications were observed.
- Cumulative 2- and 5-year survival rates were 87% and 62%, with 100% graft patency and 80% arterial revascularization patency.
Conclusions:
- Elective surgical repair of thoracoabdominal aneurysms using a diaphragm-splitting incision is recommended.
- Temporary shunts or cold kidney perfusion are effective protective measures against perioperative ischemia.
- The technique offers favorable long-term survival and excellent graft patency rates.