open repair of abdominal and thoracoabdominal aortic aneurysms · open repair of abdominal aortic...

Department of Cardiothoracic and Vascular Surgery McGovern Medical School / The University of Texas Science Center at Houston Memorial Hermann Heart & Vascular Institute

Zain Al Rstum, MD

Open Repair Of Abdominal And Thoracoabdominal Aortic Aneurysms

Aortic Aneurysms:

• Ascending

• Arch

• Descending

• Abdominal

• Thoracoabdominal

leadwayservice.com

Ascending

en.wikipedia.org/wiki/Median_sternotomy

healthiack.com

Arch

• Usually combined

Mountsinai.org

Descending

http://circ.ahajournals.org

Abdominal

• Infrarenal (90%)

• Pararenal, Juxtarenal, Suprarenal

• Thoracoabdominal

Open Repair Of Abdominal Aortic Aneurysm

• Open repair is the direct surgical replacement of an infrarenal abdominal aortic aneurysm using a transperitoneal or retroperitoneal incision

• Dubost et al reported the first surgical repair of an infrarenal abdominal aortic aneurysm (AAA) using an arterial homograft more than 55 years ago

Comprehensive_Vascular_and_Endovascular_Surgery_Expert_Consult_-_Online_and_Print_2nd_Edition

Open Repair Of Abdominal Aortic Aneurysm


Indications for repair

• AAA repair is 5.5 cm in maximum aortic diameter or 5 cm (women)

• Symptomatic (any size)

• Rapid expansion

• Rupture

• Open: Young, CTD, Anatomically unsuitable for EVAR


Comprehensive_Vascular_and_Endovascular_Surgery_Expert_Consult_-_Online_and_Print_2nd_Edition Comprehensive_Vascular_and_Endovascular_Surgery_Expert_Consult_-

_Online_and_Print_2nd_Edition

Results

• Overall peri-operative (30-day) mortality following elective infrarenal aortic aneurysm repair is approximately 2% to 5% and appears to be lower in higher-volume centers

• Cardiac and respiratory

• Renal dysfunction

• GI

• Others

Thoracoabdominal Aortic Aneurysms

A.L. Estrera et al. / Multimedia Manual of Cardiothoracic Surgery / doi:10.1510/mmcts.2006.001933 Mastery of vascular and endovascular surgery, TAAA, Safi et al

Thoracoabdominal Aortic Aneurysms

• The decision when to operate on a patient with a TAAA involves assessment of the likelihood of aortic rupture versus the operative risk of the individual patient

• Symptomatic

• 5-6 cm

• Rapid expansion

A.L. Estrera et al. / Multimedia Manual of Cardiothoracic Surgery / doi:10.1510/mmcts.2006.001933

Mastery of vascular and endovascular surgery, TAAA, Safi et al

Mastery of vascular and endovascular surgery, TAAA, Safi et al

Results

• Mortality for descending thoracic and thoracoabdominal aortic aneurysm repair primarily depends on comorbid conditions and aneurysm extent. In 300 cases of open DTAA repair, 30-day mortality was 8% with preoperative renal insufficiency and female sex emerging as risk factors

The risk of postoperative renal failure was 17% in patients with normal preoperative GFR. In patients with a GFR of 40 or less, the risk of postoperative renal dysfunction was 38%

Results

• Neurologic Deficit:

• 4% in extent II and 1.1% in non–extent II cases

• Current rate of delayed neurologic deficit of 3%

• Gastrointestinal (GI) complications affect 7% of DTAA and TAAA repairs

• Cardiac and respiratory

Thank you

• Dr.Afifi

Thank You

open repair of abdominal and thoracoabdominal aortic aneurysms · open repair of abdominal aortic...

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