HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pasquale Mastroroberto Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mastroroberto, P. Articles by Chello, M. Search for Related Content PubMed PubMed Citation Articles by Mastroroberto, P. Articles by Chello, M.

J Thorac Cardiovasc Surg 1999;118:477-481
© 1999 Mosby, Inc.

SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE

EMERGENCY THORACOABDOMINAL AORTIC ANEURYSM REPAIR: CLINICAL OUTCOME

From the Department of Experimental and Clinical Medicine, Cardiovascular Surgery Unit, University of Catanzaro, Catanzaro, Italy.

Address for reprints: Pasquale Mastroroberto, MD, Corso Vittorio Emanuele, 58, 84123 Salerno, Italy (E-mail: pasmas{at}speednet.org).

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.

This article has been cited by other articles:

				E. S. Xenos, D. J. Minion, D. L. Davenport, O. Hamdallah, N. N. Abedi, E. E. Sorial, and E. D. Endean Endovascular versus open repair for descending thoracic aortic rupture: institutional experience and meta-analysis Eur. J. Cardiothorac. Surg., February 1, 2009; 35(2): 282 - 286. [Abstract] [Full Text] [PDF]

				J. P. Schwartz, M. Bakhos, A. Patel, S. Botkin, and S. Neragi-Miandoab Impact of pre-existing conditions, age and the length of cardiopulmonary bypass on postoperative outcome after repair of the ascending aorta and aortic arch for aortic aneurysms and dissections Interactive CardioVascular and Thoracic Surgery, October 1, 2008; 7(5): 850 - 854. [Abstract] [Full Text] [PDF]

				J. P. Schwartz, M. Bakhos, A. Patel, S. Botkin, and S. Neragi-Miandoab Repair of aortic arch and the impact of cross-clamping time, New York Heart Association stage, circulatory arrest time, and age on operative outcome Interactive CardioVascular and Thoracic Surgery, June 1, 2008; 7(3): 425 - 429. [Abstract] [Full Text] [PDF]

				R. Fattori and V. Russo Degenerative aneurysm of the descending aorta. Endovascular treatment MMCTS, December 17, 2007; 2007(1217): 2824. [Abstract] [Full Text] [PDF]

				A. Kaya, R. H. Heijmen, T. Th. Overtoom, J.-A. Vos, W. J. Morshuis, and M. A. Schepens Thoracic Stent Grafting for Acute Aortic Pathology Ann. Thorac. Surg., August 1, 2006; 82(2): 560 - 565. [Abstract] [Full Text] [PDF]

				E. Therasse, G. Soulez, M.-F. Giroux, P. Perreault, L. Bouchard, J.-F. Blair, N. Beaudoin, A. Benko, and V. L. Oliva Stent-Graft Placement for the Treatment of Thoracic Aortic Diseases RadioGraphics, January 1, 2005; 25(1): 157 - 173. [Abstract] [Full Text] [PDF]

				R Batty, C J Hammond, and S J McPherson Stent-grafting for thoracic and abdominal aneurysms: imaging, assessment and follow-up Imaging, August 1, 2004; 16(3): 240 - 252. [Abstract] [Full Text] [PDF]

				S. Melnitchouk, T. Pfammatter, A. Kadner, H. Dave, H. Witzke, O. Trentz, M. Turina, and M. Lachat Emergency stent-graft placement for hemorrhage control in acute thoracic aortic rupture Eur. J. Cardiothorac. Surg., June 1, 2004; 25(6): 1032 - 1038. [Abstract] [Full Text] [PDF]

				B. V. Czermak, P. Waldenberger, R. Perkmann, M. Rieger, I. E. Steingruber, A. Mallouhi, G. Fraedrich, and W. R. Jaschke Placement of Endovascular Stent-Grafts for Emergency Treatment of Acute Disease of the Descending Thoracic Aorta Am. J. Roentgenol., August 1, 2002; 179(2): 337 - 345. [Abstract] [Full Text] [PDF]

				N. T. Kouchoukos, P. Masetti, C. K. Rokkas, S. F. Murphy, and E. H. Blackstone Safety and efficacy of hypothermic cardiopulmonary bypass and circulatory arrest for operations on the descending thoracic and thoracoabdominal aorta Ann. Thorac. Surg., September 1, 2001; 72(3): 699 - 708. [Abstract] [Full Text] [PDF]