Open Repair of Extensive Thoracoabdominal and Thoracic Aneurysm: A Preliminary Single-Center Experience With Femorofemoral Distal Aortic Perfusion With Oxygenator and Without Cerebrospinal Fluid Drainage
Thoracoabdominal aortic aneurysms (TAAA) and extensive thoracic descending aortic aneurysms (TDA) are not accessible through standard endovascular treatment. Fenestrated and branched endograft technology was developed rapidly without widespread application. The aim of this study was to review our open repair (OR) experience of TAAA and TDA. A total of 28 patients who underwent elective OR of TAAA or TDA between January 2001 and January 2009 were analyzed retrospectively. The mean age of the patients was 65.5 years (three women). The anatomic locations of the aneurysms were as follows: six in thoracic descending aorta and 22 in thoracoabdominal aorta (14 TAAA I, two TAAA II, six TAAA III). TDA (40 patients) available for ordinary endovascular treatment and TAAA IV (35 patients) were excluded from this study. To focus on spinal cord vascularization, 25 patients were submitted for angiography. Three patients suffering from back pain required quick treatment and were excluded from angiographic investigations. Angiography procedures were contributive in 23 patients (92%). Surgical repairs were driven through left thoraco-phreno-laparotomy, with the adjunct of distal aortic perfusion (femorofemoral bypass) including the use of an oxygenator and sequential aortic cross-clamping. Cerebrospinal fluid drainage was not used in this experience. The 30-day mortality rate was 14.3% (four of 28 patients): one multiorgan failure and three pulmonary sepsis. An immediate postoperative paraplegia occurred, affecting a patient with TDA who was previously submitted for infrarenal aorta replacement, despite angiographic identification and revascularization of intercostal artery destined to spinal artery. The 1-year survival rate was 82.1% (23 of 28 patients). In the preliminary experience of this study, OR of extensive TAAA and TDA with distal aortic perfusion and an oxygenator without use of cerebrospinal fluid drainage was associated with a significant perioperative mortality rate (14.2%), a reasonable rate of paraplegia (3%), and 1-year survival rate of 82.1%.
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Catharina Hosp, EUROSTAR Data Registry Ctr, Eindhoven, NetherlandsCatharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, Netherlands
Buth, Jacob
;
Harris, Peter L.
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Catharina Hosp, EUROSTAR Data Registry Ctr, Eindhoven, Netherlands
Royal Liverpool Univ Hosp, EUROSTAR Secretariat, Eindhoven, NetherlandsCatharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, Netherlands
Harris, Peter L.
;
Hobo, Roel
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Catharina Hosp, EUROSTAR Data Registry Ctr, Eindhoven, NetherlandsCatharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, Netherlands
Hobo, Roel
;
van Eps, Randolph
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Catharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, NetherlandsCatharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, Netherlands
van Eps, Randolph
;
Cuypers, Philippe
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Catharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, NetherlandsCatharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, Netherlands
Cuypers, Philippe
;
Duijm, Lucien
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Catharina Hosp, Dept Radiol, Eindhoven, NetherlandsCatharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, Netherlands
Duijm, Lucien
;
Tielbeek, Xander
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机构:Catharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, Netherlands
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Univ Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, ItalyUniv Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, Italy
Chiesa, R
;
Melissano, G
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Univ Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, ItalyUniv Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, Italy
Melissano, G
;
Marrocco-Trischitta, MM
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Univ Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, ItalyUniv Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, Italy
Marrocco-Trischitta, MM
;
Civilini, E
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Univ Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, ItalyUniv Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, Italy
Civilini, E
;
Setacci, F
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Univ Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, ItalyUniv Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, Italy
机构:
Catharina Hosp, EUROSTAR Data Registry Ctr, Eindhoven, NetherlandsCatharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, Netherlands
Buth, Jacob
;
Harris, Peter L.
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机构:
Catharina Hosp, EUROSTAR Data Registry Ctr, Eindhoven, Netherlands
Royal Liverpool Univ Hosp, EUROSTAR Secretariat, Eindhoven, NetherlandsCatharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, Netherlands
Harris, Peter L.
;
Hobo, Roel
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h-index: 0
机构:
Catharina Hosp, EUROSTAR Data Registry Ctr, Eindhoven, NetherlandsCatharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, Netherlands
Hobo, Roel
;
van Eps, Randolph
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h-index: 0
机构:
Catharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, NetherlandsCatharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, Netherlands
van Eps, Randolph
;
Cuypers, Philippe
论文数: 0引用数: 0
h-index: 0
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Catharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, NetherlandsCatharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, Netherlands
Cuypers, Philippe
;
Duijm, Lucien
论文数: 0引用数: 0
h-index: 0
机构:
Catharina Hosp, Dept Radiol, Eindhoven, NetherlandsCatharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, Netherlands
Duijm, Lucien
;
Tielbeek, Xander
论文数: 0引用数: 0
h-index: 0
机构:Catharina Hosp, Dept Surg, NL-5602 ZA Eindhoven, Netherlands
机构:
Univ Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, ItalyUniv Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, Italy
Chiesa, R
;
Melissano, G
论文数: 0引用数: 0
h-index: 0
机构:
Univ Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, ItalyUniv Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, Italy
Melissano, G
;
Marrocco-Trischitta, MM
论文数: 0引用数: 0
h-index: 0
机构:
Univ Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, ItalyUniv Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, Italy
Marrocco-Trischitta, MM
;
Civilini, E
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h-index: 0
机构:
Univ Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, ItalyUniv Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, Italy
Civilini, E
;
Setacci, F
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h-index: 0
机构:
Univ Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, ItalyUniv Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, I-20132 Milan, Italy