Chronic aortic dissection not a risk factor for neurologic deficit in thoracoabdominal aortic aneurysm repair.
OBJECTIVE
chronic aortic dissection has long been considered a risk factor for neurologic deficit following thoracoabdominal aortic aneurysm (TAA) surgery. We reviewed our experience with regard to aneurysm extent and the use of adjunct, (distal aortic perfusion/cerebrospinal fluid drainage), and examined the impact of these factors on neurologic deficit among chronic dissection and non-dissection cases.


METHODS
between February 1991 and March 2001, we repaired 800 aneurysms of the descending thoracic and thoracoabdominal aorta. Seven hundred and twenty-nine cases were elective; 196 chronic dissection, 533 non-dissection. 182/729 (24.9%) were TAA extent II. Among these, 61/182 (33%) involved chronic dissection. Adjunct was used in 507/729 (69.6%). We conducted detailed multivariate analyses to isolate the impact of chronic aortic dissection on neurologic morbidity, with other important risk factors taken into account.


RESULTS
overall, 32/729 (4.4%) patients had neurologic deficit upon awakening; 7/196 (3.6%) in chronic dissections, and 25/533 (4.7%) in non-dissections. Adjunct had a major effect, reducing neurologic deficit in TAA extent II from 10/36 (27.8%) to 10/146 (6.9%) (p=0.001). However, in univariate and multivariate analysis, chronic dissection did not increase the risk of neurologic deficit, regardless of extent or mode of treatment.


CONCLUSIONS
in contrast to previous reports, we determined that chronic aortic dissection is not a risk factor in TAA patients.
Safi
H J
HJ
Department of Cardiothoracic and Vascular Surgery, The University of Texas at Houston Medical School, Memorial Hermann Hospital, Houston 77030, USA.
Miller
C C
CC
Estrera
A L
AL
Huynh
T T T
TT
Porat
E E
EE
Hassoun
H T
HT
Buja
L Maximilian
LM
D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000150:complications*; D002908:Chronic Disease; D004210:Dissection / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors