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
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
Comprehensive_Vascular_and_Endovascular_Surgery_Expert_Consult_-_Online_and_Print_2nd_Edition
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 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
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