SURGICAL TREATMENT STRATEGY OF THORACOABDOMINAL AORTIC ANEURYSM

A.A. Spiridonov, E.G. Tutov, V.S. Arakelyan, S.I. Pryad, A.N. Dorofeev, M.I. Stoiko
The Department of Vascular Surgery, A.N. Bakulev Scientific Center of Cardiovascular Surgery, Russian Academy of Medical Sciences,
Moscow, Russia

The paper presents 103 cases of various types of thoracoabdominal aortic aneurysms (TAA), their investigations and surgical management. The most common aneurysm causes were atherosclerosis and aortic dissection, less common – non-specific aortoarteritis and syphilitic mesoaortitis. Arterial hypertension was shown to be the most specific clinical presentation of the disease for the whole group (72%). In 42.6% of patients concurrent ischemic heart disease was revealed. Modern diagnostic image modalities were highly valuable (digital radiography, duplex scanning, CT-angiography and NMR). The scheme of surgical intervention was determined by TAA type. In 56 cases descending thoracic aorta was grafted. In 25 cases Crawford procedure with implantation of visceral, renal, intercostal and lumbar arteries was fulfilled. Hospital mortality rate was 14.4%. The rate of intra-and postoperative complications – 42%. Postoperative lower limb paraparesis and paraplegia was observed in 7 patients (6.7%). Basing on our experience we have proposed surgical and anesthetic protocol for operative treatment of TAA.

KEY WORDS: thoracic-abdominal aortal aneurysm, surgical protocol, anesthesia.

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