Surgery of thoracoabdominal aortic aneurysms

Arteriosclerotic aneurysm of the thoracoabdominal aorta, involving one or more visceral branches, was successfully operated on in eight patients. Two of the aneurysms had ruptured. The left diaphragm-splitting thoracoabdominal incision through the 8th intercostal space, using a retroperitoneal route, gave unrestricted exposure. A temporary aortofemoral shunt effectively protected abdominal organs and spinal cord from perioperative ischemic damage. The step-by-step reattachment technique into ready-made side limbs in the woven Dacron graft ensured that visceral and renal ischemic times remained within acceptable limits. Perfusion cooling of the abdominal organs was done in one patient in whom shunt could not be used. A standby autotransfusion device was life-saving in another case. All the patients recovered without major complications. Moderate elevation was found as regards serum creatinine levels in seven patients and liver enzymes in four patients, but the values normalized within a month. No paraplegic complications occurred, although all bleeding intercostal and lumbar arteries were ligated intra-aneurysmatically in seven of the eight patients. Seven patients are well 20 to 60 months postoperatively, with patent and well functioning grafts. One patient died of lung cancer after 7 months. Four of the 18 revascularized arteries in three patients were shown by control angiography to be occluded, but without serious sequelae. Our experience suggests that most thoracoabdominal aortic aneurysms are suitable for surgical correction, with acceptable risk. Elective surgery is therefore recommended.