Thoracoabdominal Aneurysm Repair: A 20-Year Perspective

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Presentation transcript:

Thoracoabdominal Aneurysm Repair: A 20-Year Perspective Mark F. Conrad, MD, Robert S. Crawford, MD, J. Kenneth Davison, MD, Richard P. Cambria, MD The Annals of Thoracic Surgery Volume 83, Issue 2, Pages S856-S861 (February 2007) DOI: 10.1016/j.athoracsur.2006.10.096 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Operative approach for repair of type II thoracoabdominal aneurysm with a clamp-and-sew technique supplemented with regional hypothermic adjuncts for renal and spinal cord protection. (A) The entire aneurysm sac is continuously exposed after proximal cross-clamp application. After completion of the proximal anastomosis, pulsatile arterial perfusion is established into the mesenteric circulation through in-line mesenteric shunting into either the celiac axis (as depicted) or the superior mesenteric artery. Thereafter, critical intercostals vessels are reconstructed (dotted line), and a single inclusion button anastomosis for reconstruction of celiac, superior mesenteric and right renal arteries is possible in the majority of cases. The left renal artery is reconstructed with a side-arm graft. (B) Regional spinal cord hypothermic protection is achieved via epidural cooling. A 4°C epidural saline infusion (arrow) is begun in anticipation of cross-clamping. Cerebrospinal fluid temperature and pressure is simultaneously monitored with a separate intrathecal catheter. See text for further details. The Annals of Thoracic Surgery 2007 83, S856-S861DOI: (10.1016/j.athoracsur.2006.10.096) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 In hospital mortality after thoracoabdominal aneurysm repair stratified by lesion extent. The Annals of Thoracic Surgery 2007 83, S856-S861DOI: (10.1016/j.athoracsur.2006.10.096) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Long-term survival after thoracoabdominal aneurysm (TAA) repair as determined by Kaplan-Meier life-table analysis. The Annals of Thoracic Surgery 2007 83, S856-S861DOI: (10.1016/j.athoracsur.2006.10.096) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Three-dimensional reconstruction of hybrid repair of a thoracoabdominal aneurysm. The long white arrow indicates the origin of the bifurcated aorto-superior mesenteric artery and aorto-celiac bypass graft. Short arrow points to origin of aorto-left renal artery bypass. The Annals of Thoracic Surgery 2007 83, S856-S861DOI: (10.1016/j.athoracsur.2006.10.096) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions