Simple Clamping and Temporary Bypass for Surgery of the Descending Thoracic Aorta

The OBJECTIVE was to analyze the experience of using a vascular prosthesis as a temporary bypass for spinal cord and visceral organs ischemia prevention during the clamping time in surgical reconstruction of thoracic and thoracoabdominal aortic aneurysm.MATERIAL AND METHODS. The study included 60 patients with the pathology of aortic arch, descending and thoracoabdominal aorta (TAAA) from 1997 to 2018. Among them, 42 (11 %) patients were diagnosed with TAAA I–IV types according to E. S. Crawford classification, 18 (32 %) – with the aortic arch aneurysm and the descending thoracic aorta. Planned interventions were performed in 43 (72 %) patients, emergency – in 17 (28 %). A temporary bypass made from vascular prosthesis with a diameter from 15 to 20 mm was used in 29 (48 %) cases as a protection of internal organs and the spinal cord against ischemia, and in 31 (52 %) surgical cases the reconstruction was performed with a cross clamping method.RESULTS. 30 days mortality was 16.6 % (n=10), total hospital mortality was 28.3 % (n=17). The mortality was 23.2 % (n=10) after planned interventions, and 41 % (n=7) – in emergency interventions. When using a temporary bypass during planned operation 9.3 % (n=4) of the patients died within 30 days, while cross clamping method without visceral protection showed 13.9 % death rate (n=6). Acute renal failure developed in 7 (11.6 %) cases and it was observed more often in the group without using of temporary bypass technique. The spinal cord ischemia turning into a spinal stroke occurred in 8 (13.3 %) cases. Five-year survival rate was 61 %.CONCLUSION. The use of a temporary bypass during the thoracic and thoracoabdominal aneurysms repair could be used for prevention of the visceral organs, kidneys and spinal cord ischemic complications during operations with need in cross clamping of the descending thoracic aorta.

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Management of thoracic aortic lesions - the future is endovascular

VASA ◽

10.1024/0301-1526/a000183 ◽

2012 ◽

Vol 41 (3) ◽

pp. 163-176 ◽

Cited By ~ 6

Author(s):

Weidenhagen ◽

Bombien ◽

Meimarakis ◽

Geisler ◽

A. Koeppel

Keyword(s):

Thoracic Aorta ◽

Clinical Decision Making ◽

Treatment Options ◽

Clinical Decision ◽

Clinical Results ◽

Treatment Modalities ◽

Traumatic Rupture ◽

Descending Thoracic Aorta ◽

New Treatment ◽

Aneurysm Dissection

Open surgical repair of lesions of the descending thoracic aorta, such as aneurysm, dissection and traumatic rupture, has been the state-of-the-art treatment for many decades. However, in specialized cardiovascular centers, thoracic endovascular aortic repair and hybrid aortic procedures have been implemented as novel treatment options. The current clinical results show that these procedures can be performed with low morbidity and mortality rates. However, due to a lack of randomized trials, the level of reliability of these new treatment modalities remains a matter of discussion. Clinical decision-making is generally based on the experience of the vascular center as well as on individual factors, such as life expectancy, comorbidity, aneurysm aetiology, aortic diameter and morphology. This article will review and discuss recent publications of open surgical, hybrid thoracic aortic (in case of aortic arch involvement) and endovascular repair in complex pathologies of the descending thoracic aorta.

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Penetrating atherosclerotic ulcer aneurysm of the innominate artery

VASA ◽

10.1024/0301-1526.38.3.263 ◽

2009 ◽

Vol 38 (3) ◽

pp. 263-266 ◽

Cited By ~ 1

Author(s):

Yuan ◽

Tager

Keyword(s):

Conservative Treatment ◽

Thoracic Aorta ◽

Open Surgery ◽

Innominate Artery ◽

Ruptured Aneurysm ◽

Descending Thoracic Aorta ◽

Penetrating Atherosclerotic Ulcer ◽

Descending Aorta

Penetrating atherosclerotic ulcer of the aorta is uncommon, and usually develops in the descending thoracic aorta. Rarely this condition involves the branch vessels of the aorta. We report a case of ruptured aneurysm of the innominate artery resulting from penetrating atherosclerotic ulcer. Open surgery was the treatment of choice for the ruptured aneurysm, while conservative treatment was recommended for the associated penetrating atherosclerotic ulcers of the descending aorta.

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