Surgical treatment of thoracoabdominal aortic pathology – retrospective study of 300 patients
Authors:
P. Štádler; P. Zdráhal; P. Vitásek; P. Matouš; L. Dvořáček
Authors place of work:
Oddělení cévní chirurgie, Nemocnice Na Homolce, Praha
Published in the journal:
Rozhl. Chir., 2022, roč. 101, č. 8, s. 381-387.
Category:
Original articles
doi:
https://doi.org/10.33699/PIS.2022.101.8.381–387
Summary
Introduction: Thoracoabdominal aortic surgery is a technically demanding and extensive treatment that has its place in the era of endovascular techniques. To ensure the best possible outcomes, it requires a well-coordinated team of surgeons, anaesthetists, intensive care physicians and other medical staff.
Methods: The authors present a series of 300 patients operated on between 1 January 2003 and 15 March 2022. Although the group included sporadic cases of severe obliterating involvement of the visceral aorta, patients with thoracoabdominal aortic aneurysms (TAAA) constituted the vast majority. All known organ preservation procedures were used during the operations. The thoraco-phreno-retroperitoneal approach was chosen in almost all TAAA cases; the thoraco-phreno-transperitoneal approach was used only in two reoperations.
Results: In this cohort, type II thoracoabdominal aneurysm according to Crawford classification was most common (33%). This was followed by type IV (32%), type III (15.3%), type I (8.7%), type V (6.7%) and other thoracoabdominal aortic procedures (4.3%).
Thirty-day mortality rate was 9.6% (2019 – 6%, 2020 – 9.5%, 2021 – 3.8%) in this group; surgical postoperative complications occurred in 36 patients (12%). Neurological complications were reported in 16 cases (5.3%), of which postoperative paraplegia was noted 6 times (2%). Temporary postoperative dialysis due to renal insufficiency was performed in 19 patients (6.3%) and 4 patients (1.3%) have entered the chronic dialysis programme. In 67 patients (23.3%), temporary tracheostomy was done postoperatively due to prolonged withdrawal from the lung ventilator.
Conclusion: Surgical treatment of the thoracoabdominal aorta is one of the most extensive procedures in vascular surgery and the mortality and morbidity rates still remain relatively high. A multidisciplinary approach, sufficient experience and a dedicated team are essential for a successful outcome of these highly specialised operations.
Keywords:
multidisciplinary approach – thoracoabdominal aorta – thoracoabdominal aneurysm – organ protection
Zdroje
1. DeBakey ME, Cooley DA. Successful resection of aneurysm of thoracic aorta and replacement by graft. JAMA 1953;152:673–676. doi:10.1001/ jama.1953.03690080017005.
2. Crawford ES. Thoraco-abdominal and abdominal aortic aneurysms involving renal, superior mesenteric, celiac arteries. Ann Surg. 1974;179:763–772. doi:10.1097/00000658-197405000-00032.
3. Coselli JS, LeMaire SA, Preventzal O, et al. Outcomes of 3309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg. 2016;151(5):1323–1338. doi:10.1016/j.jtcvs.2015.12.050.
4. Blaisdell FW, Cooley DA. The mechanism of paraplegia after temporary thoracic aortic occlusion and its relationship to spinal fluid pressure. Surgery 1962;51:351–355. Available at: https:// pubmed.ncbi.nlm.nih.gov/13869747/.
5. Miyamoto K, Ueno A, Wada T. A new and simple method of preventing spinal cord damage following temporary occlusion of the thoracic aorta by draining the cerebrospinal fluid. J. Cardiovasc. Surg. 1960;16:188–197. Available at: https:// pubmed.ncbi.nlm.nih.gov/13771492/.
6. Bavaria JE, Woo YJ, Hall RA. Retrograde cerebral and distal aortic perfusion during ascending and thoracoabdominal aortic operations. Ann Thorac Surg. 1995;60:345–352. doi:10.1016/0003- 4975(95)00447-s.
7. Coselli JS, LeMaire SA. Left heart bypass reduces paraplegia rates after thoracoabdominal aortic aneurysm repair. Ann Thorac Surg. 1999;67:1931–1934, discussion 1953–1958. doi:10.1016/s0003- 4975(99)00390-2.
8. Štádler P, Zdráhal P, Šebesta P, et al. Současné trendy v chirurgické léčbě výdutě torakoabdominální aorty. Rozhl Chir. 2011;90(1):14–23. Available at: https://pubmed.ncbi.nlm.nih. gov/21634129/.
9. Cheung AT, Pochettino A, Guvakov DV. Safety of lumbar drains in thoracic aortic operations performed with extracorporeal circulation. Ann. Thorac. Surg. 2003;76:1190–1196. doi:10.1016/s0003- 4975(03)00881-6.
10. Kashyap VS, Cambria RP, Davison K, et al. Renal failure after thoracoabdominal aortic surgery. J Vasc Surg. 1997;26:949–957. doi:10.1016/s0741-5214(97)70006-5.
11. Keyhani K, Miller CC3rd, Estrera AL, et al. Analysis of motor and somatosensory evoked potentials during thoracic and thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2009;49:36–41. doi:10.1016/j.jvs.2008.08.005.
12. Svensson LG, Crawford ES, Hess KR, et al. Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg. 1993;17:357–368. Available at: https://pubmed.ncbi.nlm.nih. gov/8433431/.
13. Coselli JS, Bozinovski J, LeMaire SA. Open surgical repair of 2286 thoracoabdominal aortic aneurysms. Ann Thorac Surg. 2007;83:S862–864; discussion S90–92. doi:10.1016/j.athoracsur.2006.10.088.
14. Lin PH, El Sayed HF, Kougias P. Endovascular repair of thoracic aortic disease: overview of current devices and clinical results. Vascular 2007;15:179–190. doi:10.2310/6670.2007.00041.
15. Go MR, Barbato JE, Dillavou ED, et al. Thoracic endovascular aortic repair for traumatic aortic transection. J Vasc Surg. 2007;46(5):928–933. doi:10.1016/j. jvs.2007.06.049.
16. Mommertz G, Sigala F, Langer S, et al. Thoracoabdominal aortic aneurysm repair in patients with Marfan syndrome. Eur J Vasc Endovasc Surg. 2008;35:181– 186. doi:10.1016/j.ejvs.2007.10.013.
17. Omura A, Tanaka A, Miyahara S, et al. Early and late results of graft replacement for dissecting aneurysm of thoracoabdominal aorta in patients with Marfan syndrome. Ann. Thorac. Surg. 2012;94:759–765. doi:10.1016/j.athoracsur. 2012.04.061.
18. Coselli JS, Green SY, Zarda S, et al. Outcomes of open distal aortic aneurysm repair in patients with chronic DeBakey type I dissection. J Thorac Cardiovasc Surg. 2014;148: 2986–2993. e1–2. doi:10.1016/j.jtcvs.2014.07.048.
19. Dayama A, Sugano D, Reeves JG, et al. Early outcomes and perioperative risk assessment in elective open thoracoabdominal aortic aneurysm repair: an analysis of national data over a five-year period. Vascular 2016;24:3–8. doi:10.1177/1708538114568416.
20. Sagban T, Kocabas F, Balzer K, et al. Outcome of septuagenarians and octogenarians after open TAAA repair. Ital J Vasc Endovasc Surg. 2012;19:21–30. Available at: https://www.researchgate.net/publication/ 285860569_Outcome_of_septuagenarians_ and_octogenarians_after_ open_TAAA_repair.
21. Dias NV, Sonesson B, Kristmundsson T, et al. Short-term outcome of spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2015;49:403–409. doi:10.1016/j.ejvs.2014.12.034.
22. Bisdas T, Panuccio G, Sugimoto M, et al. Risk factors for spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms. J Vasc Surg. 2015;61:1408–1416. doi:10.1016/j. jvs.2015.01.044.
23. Etz CD, Weigang E, Hartert M, et al. Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio- Thoracic Surgery. Eur J Cardiothorac Surg. 2015;47:943–957. doi: 10.1093/ ejcts/ezv142.
24. Safi HJ, Miller CC. 3rd, Huynh TT, et al. Distal aortic perfusion and cerebrospinal fluid drainage for tho¬racoabdominal and descending thoracic aortic repair: ten years of organ protection. Ann Surg. 2003;238:372–380, discussion 380–381. doi:10.1097/01.sla.0000086664.90571.7a.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2022 Číslo 8
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
Najčítanejšie v tomto čísle
- Complications and pitfalls of endovenous laser therapy for varicose veins of lower extremities
- Unique robotic vascular surgery procedures
- Endovenous laser ablation of saphenous veins – favorable clinical results confirm theoretical advantages of the 1940nm diode laser
- Efficacy and safety of urgent carotid endarterectomy in patients with acute ischemic stroke