Late complications after surgical exclusion of the thoracic aorta

Two patients who underwent surgical exclusion of the thoracic aorta for chronic dissecting aneurysms of the descending aorta died 4 and 8 years after surgery due to complications in part related to the operative technique. One patient developed pseudoaneurysm of the proximal aortic stump with fatal exsanguination through an aortapulmonary fistula. The other patient developed progressive dilatation of the remaining abdominal aorta with subsequent rupture. The surgical approach in this case was extremely difficult because of the previous exclusion procedure which determined a highly demanding reoperation. Although surgical exclusion of the thoracic aortic may be a useful technique in some situations, we must be aware of its early and late complications and, in our opinion, it should be seen only as an alternative treatment for very special patients with diseases of the descending thoracic aorta.