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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 2002 March;9(1):65-80
language: English, Italian
Thoracoabdominal aortic aneurysm surgery. Personal experience
Odero A., Pirrelli S., Arici V., De Troia A., Lovotti M.
From the Vascular Surgery Division IRCCS Policlinico S. Matteo - Pavia University - Pavia
Background. The surgical repair of thoracoabdominal aneurysms presents early and late complications related to organ complications like renal failure, paraparesis/paraplegia and multi-organ failure (MOF).
Methods. Out of a total 1377 operated aortic aneurysms over a 10-year period, we made a retrospective study of 79 cases of thoracoabdominal aneurysms. Patients showed the following distribution pattern in terms of anatomic-surgical extension: 22 (28%) type 1, 31 (40%) type 2, 14 (18%) type 3 and 12 (14%) type 4 according to Crawford’s classification. A total of 20 cases underwent emergency surgery (25%), 15 (15.6%) with rupture and 5 (5.2%) with fissuration of the aneurysm. By dividing the study period into two 5-year phases (1991-1995: 33 patients, and 1996-2001: 46 patients), the mortality rate for elective surgery fell from 30% in the first period to 8% in the second. The mortality rate for emergency surgery remained high over both periods: 60%.
Results. Univariate analysis (χ2 test and Mann Whitney’s U test) showed a significant correlation between the outcome of surgery and the type of admission (p=0.01), female sex (p<0.04), pre-existing hypertension (p=0.03) and clamping time (p<0.04).
Conclusions. From a review of the literature and in view of these results, it is clear that organ protection in thoracoabdominal aortic repair still represents a major obstacle in terms of mortality and morbidity which is open to major new developments.