Descending and Thoracoabdominal Aortic Reoperations

Abstract

Patients with thoracic aortic aneurysms are at significant risk of developing aneurysmal disease in other areas of their aortas [1]. Reoperations on the descending and thoracoabdominal aorta have become more common as both the safety of the initial aneurysm repair has increased and subsequent radiologic surveillance with computed tomography (CT) scanning has improved. Patients with previous repairs are requiring further replacement of untreated aortic segments, underscoring the chronic nature of aortic disease. Reoperations requiring a repeat left thoracotomy or thoracoabdominal incision carry risks similar to primary operations on the same segments of aorta with the added morbidity of significant lung injury and bleeding. This has often led surgeons to delay or decline surgery even when an operation is clearly indicated. Elective surgical repair in patients with aortic disease is the only effective treatment to eradicate the potential risk of rupture. Here, we will review our approach to reoperative repair of descending and thoracoabdominal aneurysms and highlight the literature associated with this surgical practice. We also will highlight endovascular and hybrid techniques for managing certain high-risk patients.