Surgical Treatment for Thoracoabdominal Aortic Aneurysm. Strategy for Spinal Cord/Visceral Protection in Type I or Type II Thoracoabdominal Aortic Replacement
Between May 1982 and April 1999, 100 consecutive patients underwent surgery for thoracoabdominal aortic aneurysms. The mean age was 58 years, and aortic dissection was present in 44 patients (44%). According to Crawford’s classification, type I aneurysm was present in 15 patients, type II in 40, type III in 32, and type IV in 13. Thirty-eight patients had previous aortic repair, and 11 patients had emergency operation for rupture of an aneurysm. The overall early mortality was 12% (12 of 100 patients); 7% for type 1,20% for type II, 6% for type III, and 8% for type IV. On multivariable analysis, rupture and hemorrhagic complications were found to be independent determinants for early death. The overall incidence of paraplegia/paraparesis was 7% (7 of 100 patients); 0% for type 1,5% for type II, 16% for type III, and 0% for type IV. Multivariable analysis showed that Crawford type III aneurysm and spinal ischemia time were independent determinants for paraplegia/paraparesis. The recent surgical strategies that we used for type I or type II thoracoabdominal aortic replacement included distal aortic perfusion with femoro-femoral bypass, segmental aortic cross clamping and reconstruction of patent T8-L1 by graft interposition to reduce the incidence of paraplegia, and selective visceral perfusion to protect the visceral organ. Deep hypothermia was used if staged segmental cross-clamping was not possible. The present technique could improve the surgical outcome of extensive thoracoabdominal graft replacement.