Abstract
Thoracoabdominal aortic aneurysms (TAAAs) are permanent localized dilations of the aorta that involve the celiac axis and extend proximally or distally from this point. The development and use of multimodal protective adjuncts in specialized surgical centers over the last 20 years have greatly decreased the risks traditionally associated with open thoracoabdominal aortic repair, namely, death, paraplegia, and renal failure. Nonetheless, managing patients during and after TAAA operations remains challenging, as postoperative complications may develop because of the inherent complexity of these repairs and the usual array of comorbidities. Here, we provide the nuanced details of performing open thoracoabdominal aortic repair accompanied by a comprehensive pictorial atlas. In the near future, aortic specialists will face increased demand for services as our population ages and as diagnostic capabilities improve to better identify TAAA—at the same time, fewer physicians are specializing in open aortic repair. Today, the skills to perform open TAAA repair remain in demand as there are only a handful of centers with sufficient expertise to perform such repair.
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References
Coselli JS, LeMaire SA, Preventza O, et al. Outcomes of 3309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg. 2016;151:1323–37.
Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121:266–369.
Midulla M, Renaud A, Martinelli T, et al. Endovascular fenestration in aortic dissection with acute malperfusion syndrome: immediate and late follow-up. J Thorac Cardiovasc Surg. 2011;142:66–72.
Trimarchi S, Jonker FH, Muhs BE, et al. Long-term outcomes of surgical aortic fenestration for complicated acute type B aortic dissections. J Vasc Surg. 2010;52:261–6.
LeMaire SA, Miller CC III, Conklin LD, et al. Estimating group mortality and paraplegia rates after thoracoabdominal aortic aneurysm repair. Ann Thorac Surg. 2003;75:508–13.
Wong DR, Parenti JL, Green SY, et al. Open repair of thoracoabdominal aortic aneurysm in the modern surgical era: contemporary outcomes in 509 patients. J Am Coll Surg. 2011;212:569–79.
Coselli JS, LeMaire SA. Left heart bypass reduces paraplegia rates after thoracoabdominal aortic aneurysm repair. Ann Thorac Surg. 1999;67:1931–4.
Coselli JS, LeMaire SA. Tips for successful outcomes for descending thoracic and thoracoabdominal aortic aneurysm procedures. Semin Vasc Surg. 2008;21:13–20.
Coselli JS, LeMaire SA, Köksoy C, et al. Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: results of a randomized clinical trial. J Vasc Surg. 2002;35:631–9.
Köksoy C, LeMaire SA, Curling PE, et al. Renal perfusion during thoracoabdominal aortic operations: cold crystalloid is superior to normothermic blood. Ann Thorac Surg. 2002;73:730–8.
LeMaire SA, Jones MM, Conklin LD, et al. Randomized comparison of cold blood and cold crystalloid renal perfusion for renal protection during thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2009;49:11–9.
LeMaire SA, Carter SA, Coselli JS. The elephant trunk technique for staged repair of complex aneurysms of the entire thoracic aorta. Ann Thorac Surg. 2006;81:1561–9.
Coselli JS, LeMaire SA, Carter SA, et al. The reversed elephant trunk technique used for treatment of complex aneurysms of the entire thoracic aorta. Ann Thorac Surg. 2005;8:2166–72.
Kulik A, Castner CF, Kouchoukos NT. Patency and durability of presewn multiple branched graft for thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2010;51:1367–72.
LeMaire SA, Carter SA, Volguina IV, et al. Spectrum of aortic operations in 300 patients with confirmed or suspected Marfan syndrome. Ann Thorac Surg. 2006;81:2063–78.
de la Cruz KI, LeMaire SA, Weldon SA, et al. Thoracoabdominal aortic aneurysm repair with a branched graft. Ann Cardiothorac Surg. 2012;1:381–93.
LeMaire SA, Jamison AL, Carter SA, et al. Deployment of balloon expandable stents during open repair of thoracoabdominal aortic aneurysms: a new strategy for managing renal and mesenteric artery lesions. Eur J Cardiothorac Surg. 2004;26:599–607.
Acknowledgments
We thank Stephen N. Palmer, PhD, ELS and Susan Y. Green, MPH for contributing to the editing of the manuscript. Figures were used with permission from Baylor College of Medicine.
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Ouzounian, M., LeMaire, S.A., Weldon, S.A., Coselli, J.S. (2019). Current Open Treatment of Thoracoabdominal Aortic Aneurysms. In: Stanger, O., Pepper, J., Svensson, L. (eds) Surgical Management of Aortic Pathology. Springer, Vienna. https://doi.org/10.1007/978-3-7091-4874-7_77
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DOI: https://doi.org/10.1007/978-3-7091-4874-7_77
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