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Ann Thorac Surg 2002;74:S1881-S1884
© 2002 The Society of Thoracic Surgeons

Session 4: Descending/Thoracoabdominal Aorta

Thoracoabdominal aortic aneurysm repair: review and update of current strategies

Joseph S. Coselli, MDa*, Lori D. Conklin, MDa, Scott A. LeMaire, MDa

a The Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine, and The Methodist DeBakey Heart Center, Houston, Texas, USA

* Address reprint requests to Dr Coselli, 6560 Fannin St, Suite 1100, Houston, TX, 77030, USA
e-mail: jcoselli{at}bcm.tmc.edu

Presented at the Aortic Surgery Symposium VIII, May 2–3, 2002, New York, NY.

Abstract

BACKGROUND: Surgical repair of thoracoabdominal aortic aneurysms remains a technically challenging operation that requires a multimodality approach to preventing ischemic complications. The purpose of this report is to update our experience and highlight our current clinical strategies.

METHODS: Between January 1, 1986 and December 31, 2001, 1,773 patients underwent thoracoabdominal aortic aneurysm repair. The majority of these patients (1,153, 65%) required Crawford extent I or II repairs. Segmental intercostal or lumbar arteries were reattached in 1,082 patients (61%); left heart bypass was used in 686 patients (38.7%), and 173 patients (9.8%) had cerebrospinal fluid drainage.

RESULTS: The 30-day survival rate was 94.3% (1,672 patients). Postoperative complications included renal failure requiring hemodialysis in 105 patients (5.9%) and paraplegia or paraparesis in 79 patients (4.5%). Actuarial 5-year survival was 73.5% ± 1.6%.

CONCLUSIONS: This clinical experience demonstrates that current technical strategies enable patients to undergo thoracoabdominal aortic aneurysm repair with excellent early survival and acceptable morbidity.




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