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Long-term results of flow reversal and thromboexclusion method for thoracic aortic aneurysm
H Urayama1, H Ohtake, Y Watanabe
1First Department of Surgery, Kanazawa University School of Medicine, Japan.
Insights
Thromboexclusion for thoracic aortic aneurysms showed significant risks, including early death and late recurrence. This procedure is best reserved for infected aneurysms or critically ill patients.
Area of Science:
- Vascular Surgery
- Cardiovascular Research
- Aortic Aneurysm Treatment
Background:
- Investigated long-term outcomes of flow reversal and thromboexclusion for thoracic aortic aneurysms.
- Focused on patients with extensive descending thoracic aorta involvement and significant comorbidities.
Purpose of the Study:
- To evaluate the efficacy and safety of thromboexclusion in managing thoracic aortic aneurysms.
- To assess the long-term results and complications associated with this surgical technique.
Main Methods:
- Retrospective analysis of 10 patients undergoing thromboexclusion between 1981 and 1990.
- Patients had severe comorbidities; one had impending rupture requiring total aortic occlusion.
Main Results:
- High early mortality (2/10) and significant morbidity, including stroke and paraplegia.
- Late complications included aneurysm recurrence in 4 patients, leading to death in 3.
- Long-term survival was observed in 2 patients, one with reoperation for recurrence.
Conclusions:
- Thromboexclusion is associated with substantial postoperative complications and a notable risk of aneurysm recurrence.
- The procedure is recommended only for specific cases: infected aneurysms or patients with severe comorbidities where other options are limited.
Background:
The long-term results of flow reversal and thromboexclusion for the elimination of a thoracic aortic aneurysm were studied.
Methods:
We monitored the posttreatment course in 10 patients with a thoracic aortic aneurysm who underwent thromboexclusion between 1981 and 1990. All patients had comorbid factors, such as renal failure, myocardial infarction, or respiratory dysfunction, and the entire descending thoracic aorta was involved in all. One patient with impending rupture underwent permanent occlusion of both the proximal and distal aortas, and the remaining 9 patients underwent proximal aortic occlusion only.
Results:
Two patients died within 30 days of operation. Postoperative cerebral infarction occurred in 1 patient, possibly as the result of the release of atheroma emboli at the time of permanent clamping. Incomplete paraplegia occurred in 1 patient 15 months postoperatively. Two patients died as the result of comorbid conditions 3 and 39 months after operation; 1 patient died as the result of penetration of the lung by the permanent clamp 12 months after operation. An aortic aneurysm recurred in 4 patients, and 3 of them died of aneurysmal rupture 50,55, and 63 months after operation, respectively. The fourth patient with aneurysmal recurrence underwent reoperation and is alive 124 months postoperatively. Another patient is alive without recurrence 140 months postoperatively.
Conclusions:
Because of the postoperative complications and the risk of aneurysm recurrence, the thromboexclusion method should be used only in patients with an infected aneurysm or in those with a severely morbid condition.