Emergency thoracoabdominal aortic aneurysm repair: clinical outcome.
OBJECTIVE
Emergency repair of thoracoabdominal aortic aneurysm remains a formidable operation with high morbidity and mortality. Although advanced surgical and perioperative care techniques have reduced the risks in elective repair of these aneurysms, the mortality rate has remained high when emergency surgery is performed. We have evaluated the outcome of patients undergoing emergency repair of thoracoabdominal aortic aneurysm.


METHODS
Of 47 consecutive patients with thoracoabdominal aortic aneurysm observed from January 1993 to September 1998, 19 required an emergency operation. Twelve had a ruptured aneurysm and 7 an acute dissection. Twelve type I, 3 type II, 1 type III, and 3 type IV thoracoabdominal aortic aneurysms (Crawford's classification) were diagnosed. All patients were operated on via a thoracolaparotomy with partial femoral-femoral extracorporeal circulation. The cerebrospinal fluid pressure was monitored, and the aorta was replaced with a vascular graft. Patent intercostal arteries were reimplanted when feasible.


RESULTS
The early (30-day) mortality was 42.1%; there were 2 late deaths. Complications in the 11 surviving patients are summarized as follows: paraplegia/paraparesis, 3 cases; renal, 4 cases; pulmonary, 4 cases; cardiac, 1 case; cerebrovascular, 1 case; and reexploration for bleeding, 1 case. Hemodialysis and aortic dissection were predictive factors of hospital mortality.


CONCLUSIONS
Our surgical experience in emergency repair of thoracoabdominal aortic aneurysm must be considered encouraging in terms of late outcome despite the in-hospital mortality of 42.1% and serious postoperative complications in the surviving patients. Moreover, our results show that acute aortic dissection and the need for hemodialysis are predictive factors for mortality.
Mastroroberto
P
P
Department of Experimental and Clinical Medicine, Cardiovascular Surgery Unit, University of Catanzaro, Italy. pasmas@speednet.org
Chello
M
M
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007813:Laparotomy; D007902:Length of Stay; D008875:Middle Aged; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D015996:Survival Rate; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods / Q000401:mortality