Anatomic exposures in thoracoabdominal aortic surgery.
Thoracoabdominal aortic aneurysm repair requires exposure of long segments of the aorta. This often results in large, debilitating incisions that can compromise pulmonary physiology significantly and result in severe pain. Preoperative preparation and positioning of the patient as well as careful planning of the incision based on the individual's anatomy are required for successful aortic exposure. Alternative approaches such as varying the skin incision location and performing submuscular dissection can reduce postoperative discomfort. Rib resection and double thoracotomy may be needed to expose enough aorta to allow safe proximal and distal control. Improved understanding of the pathophysiology of postoperative complications may alter the approach to aortic and visceral vessel exposure and reattachment. In addition, endovascular technology continues to advance, allowing for more applications in thoracic aortic disease. A combined open and endovascular approach to thoracic aortic aneurysms may minimize the morbidity and mortality by decreasing the physiologic insult normally incurred by long thoracoabdominal incisions.
Morrissey
N J
NJ
Department of Surgery, The Mount Sinai School of Medicine, New York, NY 10029, USA.
Hollier
L H
LH
D000758:Anesthesia; D001012:Aorta, Abdominal / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery*; D006801:Humans; D011187:Posture; D014656:Vascular Surgical Procedures / Q000379:methods