Cardiovascular surgery (London, England)
-
There remains no consensus on the operative management of Thoracoabdominal aortic aneurysm (TAA). Our approach emphasizes operative expediency and simplicity (without circulatory assist techniques), avoiding anticoagulation and systemic hypothermia. ⋯ In a cohort of over 200 TAA patients (50% Types I & II) treated during the past decade perioperative mortality has been 8% and paraparesis/paraplegia occured in 7%. These figures are halved for patients treated in elective circumstances.
-
A systematic approach to paraplegia risk in the surgical treatment of thoracoabdominal aortic aneurysms based on effective strategies identified from the experimental literature is discussed. With this approach, collateral blood flow, rather than direct intercostal reimplantation, moderate hypothermia and endorphin receptor, is emphasized blockade. The result has been a 10-fold reduction in paraplegia risk in elective patients and a 5-fold reduction in acute patients. This reduction in paralysis risk has resulted in improved short- and long-term survival.
-
Aneurysms that extend from the descending thoracic aorta into the abdomen and also those that involve the visceral segments of the upper abdominal aorta are traditionally classified as thoracoabdominal. Besides the surgical exposure difficulties associated with repair of these aneurysms, the temporary interruption of renal, splanchnic, and perhaps even spinal cord flow introduces a number of potential complications that makes surgical repair of these aneurysms a daunting task. The exact incidence of thoracoabdominal aneurysms is unknown, but population studies suggest a prevalence at least a log fold less than the more common infrarenal abdominal aortic aneurysm. ⋯ Spinal cord ischemia remains a perplexing and devastating complication following thoracoabdominal aneurysm repair. A number of surgical adjuncts have been developed over the years to reduce the incidence of cord ischemic complications, yet a great deal of controversy still exists with regards to the optimal protective strategy. A description of the incidence, natural history, and classification of thoracoabdominal aneurysms, along with associated repair techniques centered on reducing spinal cord ischemic complications will form the basis for this review.