Further experience with exsanguination for descending thoracic aneurysms

Resection and graft replacement of descending thoracic aortic aneurysms is associated with potential ischemic sequelae related to aortic cross-clamping. Such complications are minimized when the ischemic period is shorter than 30 minutes. We have devised a technique in which a single aortic cross-clamp is applied proximal to the lesion, and the distal anastomosis is performed in "open" fashion, with limited distal aortic dissection. This technique depends upon continuous autotransfusion, which allows distal aortic decompression by means of partial exsanguination through the open distal aorta and segmental spinal arteries. In addition, the period of cord ischemia from aortic clamping is minimized. From April 1989 to October 1993, we used this approach in 71 consecutive patients (50 men and 21 women), 8 (11.3%) of whom died during the early postoperative period. Complications included 6 cases of spinal cord dysfunction (8.5%) and 4 cases of renal failure (5.6%). Our success with this approach may contradict more accepted concepts of spinal cord protection from ischemic injury.