Surgical repair of aneurysms involving the suprarenal, visceral, and lower thoracic aortic segments: Early results and late outcome

Martin, Gordon H.; O׳Hara, Patrick J.; Hertzer, Norman; Mascha, Edward J.; Krajewski, Leonard P.; Beven, Edwin G.; Clair, Daniel G.; Ouriel, Kenneth

doi:10.1067/mva.2000.106481

Cited by 70 publications

(36 citation statements)

References 28 publications

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“…10 Cardiopulmonary complications after aortic surgery are also common. 11,12 Furthermore, the published results from high-volume centers may not be representative of the cardiovascular surgical community at large. A recent medical statewide audit in California noted a 19% perioperative mortality after elective thoracoabdominal aneurysm repair, with a staggering first-year mortality of 31%.…”

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confidence: 99%

Endovascular Repair of Thoracoabdominal Aneurysms

2008

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Background-Morbidity and mortality after conventional repair of thoracoabdominal aneurysms remain high. Alternative techniques have been proposed and are the subject of this report. Methods and Results-Endovascular grafts that have a means of incorporating the visceral vessels into the aortic repair were divided into devices with fenestrations and those with formal branches. Hybrid procedures whereby an extra-anatomic bypass procedure is used to provide inflow to the renal and mesenteric arteries followed by aortic relining with stent grafts were reviewed and tabulated. A description of the techniques and review of the current results are provided. Only 4 series with Ͼ10 cases of hybrid procedures have been published. The experience with such a procedure suggests feasibility, but most reports describe a persistently high risk of mortality (up to 25%). Larger series of fenestrated stent grafts to treat juxtarenal aneurysms have been published, and intermediate-term results confirm the safety and efficacy of the procedure. A larger multicenter trial is under way. Other pure endovascular methods have been used to treat thoracoabdominal aneurysms with both reinforced fenestrations and directional branches. Without counting small series (Ͻ10 cases), 2 series exist with Ϸ100 cases that noted perioperative mortality rates between 3% and 6%, without evidence of late ruptures. Conclusions-Endovascular repair of thoracoabdominal aneurysms is feasible and is associated with relatively low perioperative mortality. Several methods of visceral vessel incorporation have been described. Because of persistently high mortality, hybrid procedures will likely be relegated to nonsurgical and nonendovascular patients with sizable aneurysms. Endografts with branches continue to evolve and will be assessed in the context of clinical trials.

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Endovascular Repair of Thoracoabdominal Aneurysms

2008

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“…É creditado a Dubost, em 1951, a primeira correção bem sucedida de um aneurisma de aorta abdominal, e a Etheredge, em 1954, a primeira cirurgia de um ATA 1,5,6 . Apesar dos inúmeros avanços médicos e técnicos, os desafios do cirurgião vascular frente a essas doenças ainda são consideráveis, especialmente em relação às complicações pós-operatórias, incluindo paraplegia, insuficiência renal, isquemia do miocárdio, complicações respiratórias, distúrbios da coagulação e outras 6,7 .…”

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“…Um estudo sobre a história natural da evolução dos ATA revela que apenas 24% dos pacientes tratados conservadoramente estarão vivos após 2 anos do diagnóstico da doença, sendo que 50% das mortes são por ruptura do aneurisma 1,5 .…”

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“…Entretanto, quando comparado à correção dos aneurismas infra-renais e para-renais, apresenta índice de mortalidade e morbidade consideravelmente maior 10 . Citamse taxas de mortalidade para esse tipo de aneurisma em torno de 3,1 a 20% em cirurgias eletivas, com uma taxa de isquemia medular em torno de 1,3 a 4,5% e ocorrên-cia de insuficiência renal em 8,8 a 14% dos casos [4][5][6][7][8][9][10][11][12] .…”

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Aneurisma tóraco-abdominal inflamatório

2005

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“…In particular, reducing/avoiding perioperative spinal ischemia, renal failure, respiratory failure, and bleeding complications are important factors for surgical success. [1][2][3][4] In our institution, several modifications have been performed in terms of perioperative spinal protection and surgical technique. The strategy for the perioperative spinal protection has been established, which includes preoperative identification of the Adamkiewicz artery (AKA) using an intraarterial computed tomographic angiography.…”

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confidence: 99%

Evaluation of the Optimal Visceral Branch Configuration in Open Thoracoabdominal Aortic Repair by Computed Tomography

Kamohara

Furukawa

Itoh

et al. 2015

ATCS

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IntroductionSurgical treatment for Crawford type II-IV thoracoabdominal aneurysms (TAAAs) that require branch reconstruction of the visceral and RAs has been challenging because of the technical complexity and surgical invasiveness. In particular, reducing/avoiding perioperative spinal ischemia, renal failure, respiratory failure, and bleeding complications are important factors for surgical success. [1][2][3][4] In our institution, several modifications have been performed in terms of perioperative spinal protection and surgical technique. The strategy for the perioperative spinal protection has been established, which includes preoperative identification of the Adamkiewicz artery (AKA) using an intraarterial computed tomographic angiography. 5-7) For the surgical technique, in addition to the use of a pre-sewn multiple side-branched aortic graft to eliminate the potential of future aneurismal degeneration of the visceral patch, [8][9][10][11] we have adopted the modification of the length of the side branches. Each side branch pre-sewn to a main tubular aortic graft was intentionally lengthened relative to the vessel anatomy and was sutured to each corresponding Evaluation of the Optimal Visceral Branch Configuration in Open Thoracoabdominal Aortic Repair by Computed TomographyKeiji Kamohara, MD, PhD, Kojiro Furukawa, MD, PhD, Manabu Itoh, MD, Hiroyuki Morokuma, MD, Hideya Tanaka, MD, Nagi Hayashi, MD, and Shigeki Morita, MD, PhD Background: In thoracoabdominal aneurysm (TAAA) repair, our technical modification of visceral reconstruction using longer cut pre-sewn side branches has provided good surgical outcomes. Here, we assessed the long-term durability and patency of revascularized branches using computed tomography (CT) to confirm the validity of our approach. Methods: Early and late CT evaluations were performed in 11 TAAA patients (males: 5; mean age: 60.6 years) using the Coselli graft to evaluate the position of main graft and the diverging pattern and patency of side branches. Seven of 11 were sutured in an extraanatomical fashion using longer cut side branches. Results: In Anatomical (n = 4) and Extra-anatomical (n = 7) groups, the early patency of side branches was not significantly different. Although the late patency of right renal artery (RA) was 100% in both groups, the one of left RA was 60% in Extra-anatomical, while 100% in Anatomical. Furthermore, the main graft in Extra-anatomical was significantly posterior and leftward to the spine with left RA side branch diverging at an acute angle. Conclusions: When a pre-sewn branched graft designed for TAAA is used, the graft should be sutured in a fashion similar to normal patient anatomy to minimize the possibility of kinking of RA side branch for the patency.

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Surgical repair of aneurysms involving the suprarenal, visceral, and lower thoracic aortic segments: Early results and late outcome

Cited by 70 publications

References 28 publications

Endovascular Repair of Thoracoabdominal Aneurysms

Endovascular Repair of Thoracoabdominal Aneurysms

Aneurisma tóraco-abdominal inflamatório

Evaluation of the Optimal Visceral Branch Configuration in Open Thoracoabdominal Aortic Repair by Computed Tomography

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