[Surgical treatment of thoracoabdominal aortic aneurysms].
BACKGROUND
Aneurysms simultaneously involving the thoracic and abdominal aortas or those aneurysms that include the visceral aortic segment are defined as thoracoabdominal aortic aneurysms (ThAAA). Their treatment is one of the most difficult surgical problems today.


OBJECTIVE
The purpose of this paper is to present the early results of the surgical treatment of type IV ThAAA, according to the Crawford classification, as well as to analyse the main problems encountered during this procedure.


METHODS
Between January 2001 and the end of 2004, 79 patients with type IV ThAAA, according to the Crawford classification were treated at the Clinic for Vascular Surgery of the Institute for Cardiovascular Diseases of the Serbian Clinical Centre. Lumbotomy combined with extrapleural resection of the XI or X rib was used as the operative approach in 70 cases, while thoracophrenolumbotomy was performed in 9 cases. The aneurysm was repaired using the bifurcated Dacron graft in 38 cases and with the tube Dacron graft in 41 cases. In 47 cases, visceral arteries were reattached using the Carrel patch technique, while in 31 cases, separate revascularisation of the left kidney was required.


RESULTS
60 (76%) of our patients survived the first 30 postoperative days, while 19 (24%) died during this period. The causes of mortality included: haemorrhaging, in 4 patients; pulmonary embolism, in 1 patient; myocardial infarction, in 4 patients; ARDS, in 2 patients; and finally, multi-organ system failure, in 8 patients. Statistical analysis showed that advanced age (over 70 years), the need for more extensive reconstructive surgery along with the implantation of the bifurcated graft, as well as the presence of ruptured aneurysms, significantly increased the mortality of the patients.


CONCLUSIONS
The surgical management of ThAAA requires a multidisciplinary approach. We introduced this procedure in our hospital 4 years ago. The further development of this surgery will be of great medical, social, and economic importance to our country.
Davidović
Lazar B
LB
D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D014656:Vascular Surgical Procedures / Q000379:methods