Surgical Treatment Of Thoracoabdominal Aortic Aneurysm(Report Of7Cases)

Background: Since the France doctor Dubost made the first successful procedure ofabdominal aortic aneurysm (AAA) resection and heterogenous aortic grafting in1951, Thesurgical technique of abdominal aortic aneurysm and the materials of prosthetic grafts aregradually maturity. These make the operation of abdominal aortic aneurysm resection andthe prosthetic vascular replacement successful, which means the radical operation ofabdominal aortic aneurysm arriving. But thoracoabdominal aortic aneurysm (TAAA) has itscomplex feature in anatomy which makes the treatment of TAAA is still a difficult point atdomestic and abroad.Objective：To analyse the clinical data of thoracoabdominal aortic aneurysm patientswho underwent the traditional open operation treatment and to summary the surgicalprocedures and postoperative management experience, search reasonable surgical therapy,decrease perioperative complications and improve the cure rate of open TAAA repair.Methods: Retrospectively reviewed the7cases of TAAA patients who underwent openrepair in Vascular department of China-Japan Union Hospital of Jilin University betweenMay2009and December2012，4males，3females，with a mean age of46.7years (rangefrom20years to62years). Reviewed general informations (including: preoperative imagingassessment---7cases were all diagnosed by CTA or DSA, individual surgical approach,duration of surgery, blood loss, blood transfusion, biochemical markers preoperative andpostoperative, perioperative complications,hospitalization days postoperative, long-termresults and other indicators).Results: The7cases were all underwent elective surgery.①Incision length was30~50cm, average42cm.②Surgery duration was320~660min, average503min.③Thebleeding amount1500~6100ml,average4929ml.④Blood transfusion1200~6300ml,averagewas5085ml.⑤Postoperative mechanical ventilation time was approximately7~46h,average18.6h.⑥Postoperative hospitalization time was13~29d, average18d.Perioperative complications: one case underwent splenectomy because of splenicrupture during operation, one case of postoperative induced severe stress ulcer bleeding, twocases had postoperative transient serum creatinine and urea increased, one case happened acute renal failure and acute respiratory distress syndrome. There were no postoperativecomplications of paraplegia,intestinal ischemia and distal limb embolism.Outcomes: One case died during postoperative hospitalization due to severe stress ulcerbleeding. Follow-up after discharged from3months to4years, one case was dead ateleventh month due to malignant tumor(the cancer of stomach), the other five patients arestill alive normally.Conclusion: Improved Crawford approach for open surgical repair of an aorticaneurysm simplifies important visceral arterial reconstruction, it make the procedureorderly、safely and improve the success rate. Aortic aneurysm “lumen-tube” approachguarantee spinal Adamkiewicz artery blood supply and avoid the occurrence of paraplegia.