Descending thoracic aortic aneurysm: a 10 year surgical experience

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Descending thoracic aneurysms require complex surgical repair.
• Traditional methods may involve heparinization, increasing bleeding risks.
• Alternative techniques are sought to improve patient outcomes and safety.

Purpose of the Study:

• To evaluate the efficacy and safety of heparinless femorofemoral venoarterial bypass for descending thoracic aneurysm resection.
• To compare this approach with simple aortic cross-clamping in specific scenarios.
• To discuss alternative bypass strategies for complex cases like aortoesophageal fistula.

Main Methods:

• Heparinless femorofemoral venoarterial bypass for descending thoracic aneurysm resection.
• Simple aortic cross-clamping for acute traumatic aortic rupture.
• Pharmacological control of proximal hypertension.
• Discussion of permanent extrathoracic bypass for contaminated fields.

Main Results:

• Heparinless bypass offers advantages: minimal blood loss, ease of insertion, distal perfusion, and prevention of left heart overload.
• Simple aortic cross-clamping is a safe and expeditious alternative for acute traumatic ruptures.
• Permanent extrathoracic bypass is proposed for aortoesophageal fistula and infected grafts.

Conclusions:

• Heparinless femorofemoral bypass is the preferred method for descending thoracic aneurysm resection.
• Simple aortic cross-clamping is a viable option for acute traumatic ruptures.
• Alternative bypass strategies are essential for managing complex and contaminated thoracic aortic pathologies.