Surgical repair of thoracoabdominal aortic aneurysms and dissections using the femoro-femoral distal perfusion technique

Background: Ischemia of distal vital organs and reperfusion injury are the most important complications during surgical repair of thoracoabdominal aortic aneurysms and dissections. Distal femoro-femoral perfusion can reduce this risk in these patients. We evaluated the results of our patients operated on with this technique. Methods: The study included 15 patients (12 males, 3 females; mean age 50 +/- 14 years; range 29 to 80 years) who underwent 17 operations using the femoro-femoral perfusion technique for the treatment of thoracoabdominal aortic aneurysms and dissections. Of these, 14 (82.4%) were elective, and three (17.6%) were emergency operations. While normal arterial and venous filling pressures were maintained in the proximal aorta, femoro-femoral perfusion was employed at 1000-1500 ml/min to keep the arterial pressure at 60-70 mmHg in the distal aorta. Rectal temperature was kept above 30 degrees C. The mean follow-up was 3.5 +/- 19 years (range 0.8 to 6.8 years). Results: Operative mortality occurred in four patients (23.5%) in the early postoperative period, being 66.7% in emergency cases and 14.3% in elective cases. Complications included respiratory problems (n=3, 17.6%), transient acute renal failure (n=3, 17.6%), paraplegia (n=1, 5.8), and temporary paraparesis (n=1, 5.8). Conclusion: The use of the distal femoro-femoral perfusion technique to protect visceral organs and prevent spinal cord ischemia may decrease mortality and morbidity in patients undergoing surgery for thoracoabdominal aortic aneurysms and dissections.