[Long-term survival after treatment of thoracic aneurysms by thromboexclusion operation]

Since 1982, fourteen patients with aortic aneurysms received thromboexclusion operation. This method was performed in 7 patients with dissecting aortic aneurysms, 6 patients with true thoracic aneurysms, and 1 patient with true thoracoabdominal aneurysm. Among them, 12 patients received the operation of ascending aorta-supraceliac abdominal aorta bypass, one patient received descending aorta-descending aorta bypass, and another one received bilateral axillo-iliac artery bypass. Graft sizes in diameter were from 16 mm to 22 mm. 9 patients received permanent paired-clamps at both the proximal and the distal parts of the thoracic aneurysm, and 5 patients received permanent single-clamp only at the proximal part of the thoracic aneurysm. 5 patients (35.7%) died perioperatively because of low output syndrome, cerebral infarction, hepato-renal insufficiency, and aneurysmal rupture, respectively. 4 late deaths (28.6%) occurred after 4 months, 5 months, 26 months, and 5 years of operation, respectively. Among them, three deaths were due to aneurysmal rupture and one due to heart failure. Although paired-clamps at both the proximal and the distal parts of the thoracic aneurysm were performed in 1 to 3 ruptured-cases, thrombo-occlusion of the thoracic aorta did not occur in any of the cases. Long-term survival was 35.7% in 5 patients after 14 years and 4 months of mean follow-up. Although a single-clamp only at the proximal part of the thoracic aneurysm was performed in 2 of these 5 cases, thrombo-occlusion of the thoracic aorta occurred in all cases. For the four survivors of them, we ran a follow-up survey and found left ventricular hypertrophic pattern in ECG, concentric left ventricular hypertrophy in UCG, and hypertension, but those were absent before operation. We conclude that thromboexclusion method for thoracic aneurysm should be limited only to high-risk patients particularly in bad conditions or to cases with severe adhesion to lung which seem to be inaccessible through direct approach.