THORACOABDOMINAL ANEURYSM REPAIR:  A 15-YEAR EXPERIENCE

L Carvalho Perron, L Garrido-Olivares, C Hinojosa, B Doobay, J Tittley, D Szalay, C S Cinà 
Division of Vascular Surgery, McMaster University, Ontario, Canada

Purpose. To report the 15-year experience with the treatment of elective and urgent thoracoabdominal aortic aneurysms (TAAA), and describe the contemporary surgical approach to this condition.

Method: This is retrospective review of prospectively collected data at a tertiary vascular centre between November 1990 to June 2006.  Surgical techniques changed in 1997 and results are reported for the entire cohort and also according to the two different time periods (T1 and T2). The Clamp-and-go technique was performed from October 1990 to September1997.  From 1997 to 2006 the protocol was modified and included the use of left atriofemoral bypass (AFB), sequential clamping, reinsertion of intercostals arteries below the T5-6 level, and CSFD drainage.  The primary outcomes were mortality, neurologic deficits, and need for dialysis.  Univariate and multivariate analyses were used.

Results.  A total of 237 patients underwent TAAA repair: 143 males (60%), age 68 ± 11 years; Type I, 17%; Type II, 22%; Type III 16%; Type IV 45%; 176 were elective procedures (Type I, 18%; Type II, 24%; Type III, 15%; Type IV, 43%); and 61 urgent (Type I, 15%; Type II, 15%; Type III, 20%; Type IV, 51%).  Overall mortality was 18 % (Type I, 2 %; Type II 28%; Type III, 36%; Type IV, 13%): elective 14% and urgent 31%.  In T1 elective mortality was 18% and in T2 10%.  Overall, neurologic events in the elective group occurred in 4% [T1 = 8% (Type 1, 7%; Type II, 13%; Type III, 5%; and Type IV, 0 ); T2 = 2% (Type 1, 0; Type II, 6%; Type III, 6%; and Type IV, 3%).  Overall, permanent dialysis was required in 6% of elective patients [T1 = 0%; T2 = 8% (Type 1, 9%; Type II, 17%; Type III, 8%; and Type IV, 8%).  Results will be also presented adjusted according to baseline characteristics.

Conclusion.  Traditional surgical treatment of TAAA is still burdened with severe mortality and morbidity in spite of improvements in surgical, anaesthesiologic and intensive care techniques.