Fractionated-clamping for thoracoabdominal aortic aneurysm repair: a modified Crawford technique.
OBJECTIVE
To apply fractionated-clamping for repair of thoracoabdominal aortic aneurysm (TAA), and evaluate its effects in decreasing surgical mortality and severe complications, such as renal failure and paraplegia, a modified crawford procedure were prospectively evaluated.


METHODS
Using modified shunting and cross-clamping techniques, modified Crawford repair in 13 thoracoabdominal aorta patients were performed in the Vascular Division at Peking Union Medical College Hospital. TAA Crawford classification: 1 type I, 2 type II, 2 type III and 3 type IV TAA. Debakey classification: 1 type I, 4 type III (including 2 ruptured aneurysms), and 1 aortic coarctation.


RESULTS
Thirteen procedures were performed successfully. One died of ventricular fibrillation just before completing the operation. Surgical mortality rate was 7.7% (1/13). Postoperative complications included 1 acute necrotic pancreatitis, 1 ARDS, 1 paraplegia, 1 acute renal failure, and 2 thoracic cavity bleeding. Total complication rate was 53.8% (7/13).


CONCLUSIONS
Fractionated-clamping in thoracoabdominal aortic aneurysm repair is our modified Crawford procedure and aortic bypass. Clinical results demonstrate that our procedure decreased surgical mortality and major complication rate, and also alleviated viscera ischemic injury. Fractionated-clamping in aorta replacement is a practical procedure for TAA repair under general anesthesia at normal temperature.
Guan
Heng
H
Division of Vascular Surgery, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China. Guanheng518@hotmail.com
Zheng
Yuehong
Y
Li
Yongjun
Y
Liu
Changwei
C
Liu
Bao
B
Zhang
Yan
Y
Ye
Wei
W
D000328:Adult; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged