Evolution of Surgical Techniques for Aneurysms of the Descending Thoracic Aorta: Twenty-Nine Years Experience with 659 Patients

Abstract

Between 1953 and 1993, 659 patients underwent descending thoracic aneurysm resection. The most common etiology was atherosclerosis. Pain was the main presenting symptom. Perioperative mortality fell from 24.2% between 1953 and 1964 to 14.3% between 1970 and 1993. Paraplegia occurred in 4.1% (27/659) patients overall and was little affected by time of operation or use of atriofemoral bypass. Paraparesis occurred in 5.9% (39/659) patients and was reduced by use of atriofemoral bypass. The low rate of paraparesis in the earlier experience was offset by the higher perioperative mortality from hemorrhage, attributable to the use of systemic heparin. The use of heparin-free circuits with centrifugal pumps should be considered in patients likely to have a clamp time greater than 30 minutes. The major source of perioperative morbidity and mortality was cardiac causes (48%) followed by perioperative hemorrhage (14.4%), pulmonary complications (14.4%), and rupture of another aneurysmal segment (12.0%). Late mortality occurred most commonly from cardiac causes (30.6% of deaths) and rupture of another aneurysm (16.3% of deaths). Improvement in results was due to general refinements of management in all areas rather than any single factor. These results indicate that complete preoperative assessment of the patient and the entire aorta is essential and that regular life-long follow-up is critical in order to avoid unnecessary morbidity and mortality from cardiac, cerebrovascular, or subsequent aneurysmal complications.

International controlled clinical trial of thoracic endovascular aneurysm repair with the Zenith TX2 endovascular graft: 1-year results

“…In contrast to the spinal ischemic event rate with open repair reported in other multicenter TEVAR studies, 12 the rate of spinal ischemic events in the open group from this study appeared to be largely comparable with those reported in several large single-center experiences (1.5%-6.3%), 2,6,[13][14][15] even though 28 institutions contributed at least one open patient. Nonstatistically significant differences between open and TEVAR in spinal ischemic events have been reported previously.…”

A Case of Stent Graft Infection Coupled With Aorto-Esophageal Fistula Following Thoracic Endovascular Aortic Repair in a Complex Patient

“…The incidence of PGI ranges between 0.5-5%3) and secondary AEF after TEVAR ranges from 0.5% to 1.7% 4). Prompt diagnosis of these complications is critical due to the high mortality rate, ranging from 20% to 40% 5).…”

Strategies for Spinal Cord Protection during Descending Thoracic and Thoracoabdominal Aortic Surgery: Up-to-date Experimental and Clinical Results - A review

“…In fact, it has been showed that aortic cross-clamping time is a main predictor of postoperative spinal cord dysfunction (4, 5), a cross-clamp time over 30 min being associated with a signi cantly increased risk of paraplegia (5,65,66). Indeed, without distal aortic perfusion and any other neuroprotective methods such as hypothermia and cerebrospinal uid monitoring and drainage the risk of spinal cord ischemic injury is greatly increased (67).…”