Surgical repair of thoracoabdominal aortic aneurysm: 10 years' experience

Between 1983 and 1993, a total of 110 patients underwent elective repair of thoracoabdominal aortic aneurysm. Mortality rate varied with the extent of repair: 26 per cent (five of 19) after type I repair, 42 per cent (eight of 19) after type II repair, 24 per cent (four of 17) after type III repair and 15 per cent (eight of 55) after type IV repair. A further 20 patients underwent urgent operation for suspected rupture in nine and true rupture in 11. The mortality rate was 73 per cent for those with true rupture and 33 per cent for those with threatened or contained rupture. Death was most commonly due to coagulopathy and bleeding (39 per cent) or myocardial ischaemia (19 per cent). Preoperative risk factors for death included type II repair, urgent or emergency operation, aortic dissection, impaired renal function and abnormal spirometry (P < 0.05). Postoperative risk factors included reoperation, dialysis or prolonged ventilation (P < 0.05). Twenty patients required dialysis; ten died, five recovered normal renal function and five were discharged on dialysis. Eight patients developed paraplegia and four of them died. Thoracoabdominal aneurysm remains a formidable surgical challenge, but 90 per cent of survivors are free of major morbidity.