Journal «Angiology and Vascular Surgery» • 

2019 • VOLUME 25 • №2

Open surgical treatment of aneurysms and dissection of the thoracic and thoracoabdominal aorta

Shlomin V.V.1, Gordeev M.L.2, Bondarenko P.B.2, Yurtaev E.A.1, Didenko Yu.P.1, Puzdryak P.D.1, Drozhzhin I.G.1, Kasyanov I.V.1, Gusinsky A.V.2, Grebenkina N.Yu.1, Zvereva E.D.2

1) Municipal Multimodality Hospital №2,
2) National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia

Presented herein is experience in treating a total of 56 patients with pathology of the arch, descending and thoracoabdominal aorta from 1997 to 2017. Of these, 6 (11%) patients were diagnosed with a Crawford type I-II thoracoabdominal aortic aneurysm (TAAA), 20 (35%) patients with Crawford type III-IV TAAA, 18 (32%) were diagnosed as having an aortic arch aneurysm (AAA) and descending thoracic aortic aneurysm (DTAA), 12 (22%) had DeBakey type I and IIIb aortic dissection. To protect the visceral organs and spinal cord from ischaemia in 28 (50%) cases we used a temporal bypass from a synthetic vascular graft with zero porosity and measuring from 15 to 20 cm in diameter.

Results. Mortality within 30 days amounted to 14.3% (n=8), that after 30 days amounted to 10.7% (n=6): in elective operations – 12% (n=5) and 5.4% (n=3), in emergency operations – 21% (n=3) and 21.4% (n=3), respectively. The total in-hospital mortality amounted to 25% (n=14), equalling 19% (n=8) and 43% (n=6) for elective and emergency operations, respectively. Mortality in using temporal bypass in elective operation amounted to 9.5% (n=2) during 30 days and that without using this method to 14.3% (n=3), after 30 days being 9.5% (n=2) and 4.7% (n=1), respectively. Mortality for emergency cases with a temporal shunt during 30 days was 28.6% (n=2), without – 14.3% (n=1), after 30 days – 28.6% (n=2), without – 14.3% (n=1). In type I-II TAAA mortality within 30 days was 16.6% (n=1), after 30 days – 50% (n=2); type III-IV TAAA – 10% (n=2) and 15% (n=1); DTAA – 22.2% (n=4) and 33.3% (n=2); aortic dissection – 8.3% (n=1) and 16.6% (n=1). Acute renal failure (ARF) occurred in 6 (10.7%) patients and was more often observed in the group without temporal shunting. Events of spinal cord ischaemia with the development of spinal stroke occurred in 6 (10.7%) cases. Five-year survival amounted to 61%.

Conclusions. Temporal bypass in surgery of the thoracic and thoracoabdominal aorta may be used for prevention of ischaemia of visceral organs, kidneys and spinal cord in operations accompanied by cross-clamping of the descending thoracic aorta.

KEY WORDS: thoracoabdominal aortic aneurysm, descending thoracic aortic aneurysm, temporal bypass graft in aortic surgery, thoracoabdominal aortic dissection, aortic arch pathology.

P. 185

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