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Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
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Open thoracoabdominal aortic aneurysm surgery technique: how we do it.

Akiko Tanaka1, Anthony L Estrera1, Hazim J Safi2

  • 1McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.

The Journal of Cardiovascular Surgery
|February 15, 2021
PubMed
Summary

Modern thoracoabdominal aortic aneurysm (TAAA) repair techniques significantly reduce spinal cord ischemia. Advanced adjuncts and meticulous surgical strategies protect vital organs during TAAA repair, improving patient outcomes.

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Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Aortic Aneurysm Repair

Background:

  • Thoracoabdominal aortic aneurysm (TAAA) repair presents significant challenges, particularly concerning multiorgan protection.
  • The spinal cord is a highly vulnerable organ during TAAA repair, with historical high rates of ischemic injury.

Purpose of the Study:

  • To describe current open surgical techniques for extent II TAAA repair.
  • To highlight the use of adjuncts for multiorgan protection, focusing on preventing spinal cord ischemia.

Main Methods:

  • Detailed description of surgical steps: anesthesia, monitoring, TAAA exposure, bypass, graft replacement, artery reattachment, and reconstructions.
  • Implementation of cerebrospinal fluid drainage, distal aortic perfusion, hypothermia, sequential clamping, and visceral/renal perfusion.
  • Utilizing motor-evoked potentials and somatosensory-evoked potentials for guiding intercostal artery reattachment.

Main Results:

  • Adjuncts reduced spinal cord ischemia rates from 15% to <2% for Extent I TAAA.
  • Adjuncts reduced spinal cord ischemia rates from 33% (or 50% with prolonged clamping) to <4% for Extent II TAAA.

Conclusions:

  • Current standard TAAA repair practices, utilizing adjuncts, have substantially improved outcomes.
  • These advancements have significantly decreased the incidence of spinal cord ischemia following TAAA repair.