Department of Cardiothoracic and Vascular Surgery McGovern Medical School / The University of Texas Science Center at Houston Memorial Hermann Heart & Vascular Institute Zain Al Rstum, MD Open Repair Of Abdominal And Thoracoabdominal Aortic Aneurysms
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Open Repair Of Abdominal And Thoracoabdominal Aortic Aneurysms · Open Repair Of Abdominal Aortic Aneurysm •Open repair is the direct surgical replacement of an infrarenal abdominal
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Department of Cardiothoracic and Vascular Surgery McGovern Medical School / The University of Texas Science Center at Houston Memorial Hermann Heart & Vascular Institute
Zain Al Rstum, MD
Open Repair Of Abdominal And Thoracoabdominal Aortic Aneurysms
Aortic Aneurysms:
• Ascending
• Arch
• Descending
• Abdominal
• Thoracoabdominal
leadwayservice.com
Ascending
en.wikipedia.org/wiki/Median_sternotomy
healthiack.com
Arch
• Usually combined
Mountsinai.org
Descending
http://circ.ahajournals.org
Abdominal
• Infrarenal (90%)
• Pararenal, Juxtarenal, Suprarenal
• Thoracoabdominal
Open Repair Of Abdominal Aortic Aneurysm
• Open repair is the direct surgical replacement of an infrarenal abdominal aortic aneurysm using a transperitoneal or retroperitoneal incision
• Dubost et al reported the first surgical repair of an infrarenal abdominal aortic aneurysm (AAA) using an arterial homograft more than 55 years ago
• Overall peri-operative (30-day) mortality following elective infrarenal aortic aneurysm repair is approximately 2% to 5% and appears to be lower in higher-volume centers
A.L. Estrera et al. / Multimedia Manual of Cardiothoracic Surgery / doi:10.1510/mmcts.2006.001933 Mastery of vascular and endovascular surgery, TAAA, Safi et al
Thoracoabdominal Aortic Aneurysms
• The decision when to operate on a patient with a TAAA involves assessment of the likelihood of aortic rupture versus the operative risk of the individual patient
• Symptomatic
• 5-6 cm
• Rapid expansion
A.L. Estrera et al. / Multimedia Manual of Cardiothoracic Surgery / doi:10.1510/mmcts.2006.001933
Mastery of vascular and endovascular surgery, TAAA, Safi et al
Mastery of vascular and endovascular surgery, TAAA, Safi et al
Results
• Mortality for descending thoracic and thoracoabdominal aortic aneurysm repair primarily depends on comorbid conditions and aneurysm extent. In 300 cases of open DTAA repair, 30-day mortality was 8% with preoperative renal insufficiency and female sex emerging as risk factors
The risk of postoperative renal failure was 17% in patients with normal preoperative GFR. In patients with a GFR of 40 or less, the risk of postoperative renal dysfunction was 38%
Results
• Neurologic Deficit:
• 4% in extent II and 1.1% in non–extent II cases
• Current rate of delayed neurologic deficit of 3%
• Gastrointestinal (GI) complications affect 7% of DTAA and TAAA repairs