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Giornale Italiano di Chirurgia Vascolare 2002 March;9(1):81-100

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: English, Italian

Surgical treatment of thoracic and thoracoabdominal aortic aneurysms: experience with left atriofemoral bypass

Chiesa R., Melissano G., Jannello A. M., Civilini E., Castellano R., Moura M. R. L., Magrin S., Zangrillo A.

From the Vascular Surgery, IRCCS S. Raffaele, “Vita e Salute” University - Milan


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Background. The aim of ­this ­study was to ana­lyse per­i­op­er­a­tive mor­bid­ity and mor­tal­ity in ­patients under­go­ing tho­rac­ic (TAA) and thor­a­coab­dom­i­nal aor­tic aneu­rysm (­TAAA) sur­gery at the Department of Vascular Surgery of ­IRCCS San Raffaele, Milan.
Methods. The ­study includ­ed 258 ­patients (199 ­males and 59 ­females) ­with a ­mean age of 66 (­range: 41-82 ­years) under­go­ing 259 oper­a­tions for aneu­rys­mec­to­my of TAA or ­TAAA ­between January 1988 and April 2000. Cerebral spi­nal ­fluid drain­age (­CSFD) was ­used in 166 cas­es (75% of ­TAAA, 53% of TAA; 183 ­patients (98 ­TAAA and 85 TAA) ­were oper­at­ed on ­with the use of ­left atri­of­e­mo­ral ­bypass ­using a Biomedicus ­pump.
Results. The over­all mor­tal­ity ­rate at 30 ­days was 33/259 (13%); a ­total of 26 ­deaths (11%) ­were record­ed dur­ing elec­tive sur­gery and 7 (32%) in ­patients under­go­ing emer­gen­cy ­repairs. The fol­low­ing per­i­op­er­a­tive com­pli­ca­tions ­were report­ed: par­a­ple­gia/par­a­par­e­sis in 20 cas­es (8%), res­pir­a­to­ry fail­ure requir­ing pro­longed intu­ba­tion in 62 cas­es (24%), car­diac com­pli­ca­tions (­major arrhyth­mia, myo­car­dial infarc­tion) in 26 cas­es (10%), ­renal fail­ure in 18 cas­es (7%), post­op­er­a­tive bleed­ing requir­ing ­redo sur­gery in 12 cas­es (5%), ­graft infec­tion in 5 cas­es (2%).
Conclusions. Morbidity and mor­tal­ity con­se­quent to ­TAAA and TAA sur­gery are ­still ­high. However, ­based on our expe­ri­ence, the use of atri­o­dis­tal ­bypass, sequen­tial ­cross-clamp­ing and ­CFSD ­enables accept­able ­results to be ­achieved and reduc­es com­pli­ca­tions sec­on­dary to spi­nal ­cord and vis­cer­al ische­mia with­out the ­need for expe­di­tious clamp­ing ­times.

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