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ORIGINAL ARTICLE

Surgical treatment of thoracoabdominal aortic aneurysms

Januário M Souza; Marcos F Berlinck; Salomon O Rojas; Dante F Senra; Paulo A. F Oliveira; José Renato M Martins; Ricardo Mazzieri; Sérgio Almeida de Oliveira

DOI: 10.1590/S0102-76381991000100004

ABSTRACT

Five patients have been operated on of thoracoabdominal aortic aneurysms. The mean age was 53 years (range 31-71) and three were women. All the patients were symptomatic, three of them had arteriosclerotic aneurysms, and the other two had dissecting aneurysms. Three patients had been operated on previously. The exposure of aneurysm was made through a thoracoabdominal incision, in four patients clamps were placed above and below the aneurysm and it was incised longitudinally. Bypass between left atrium and left femoral artery with hypothermia and circulatory arrest was used in the other patients, since the proximal thoracic aortic clamping was impossible. A woven Dacron graft of adequate size was used to substitute the aorta, intercostals and visceral arteries were reimplanted. Paraplegia occurred in one patient. There was no intraoperative death. Two patients died in the immediate postoperative period, one of them on the 3rd day, by neurologic coma caused by cardiac arrest during the operation, and the other patient on the 12th postoperative day, suddenlly. Three patients were followed up. Two patients are doing well, 13 and 72 months after operation, and the other one has the limitation of the paraplegia.

RESUMO

Foram operados, em nosso Serviço, 161 aneurismas da aorta, sendo 99 por dissecção e 62 por outras causas. Em cinco pacientes, os aneurismas eram de localização toracoabdominal, sendo três por degeneração aterosclerótica e dois por dissecção; três pacientes eram do sexo feminino e a idade variou de 31 a 71 anos. Dois pacientes submeteram-se a aneurismectomia previamente (um da aorta ascendente e outro da porção proximal da aorta torácica). Revascularização miocárdica foi feita em um paciente, 40 dias antes da aneurismectomia. A indicação em todos os pacientes foi dor, causada por compressão do aneurisma, sendo que, em dois, havia insuficiência respiratória associada. Todos os pacientes foram operados através de incisão toracoabdominal e abertura do diafragma. A aorta foi substituída por tubo de Dacron, desde sua porção proximal até sua bifurcação, e as artérias viscerais foram implantadas no tubo. Quatro pacientes foram operados com pinçamento da aorta; um paciente necessitou emprego de circulação extracorpórea e parada circulatória, por impossibilidade de pinçamento da aorta junto à artéria subclávia. Todos os pacientes sobreviveram ao ato cirúrgico, ocorrendo dois óbitos no pós-operatório, um subitamente no 12º dia e outro por coma neurológico secundário a parada cardíaca causada por hipoxia.
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REFERENCES

1. ADAMS, H. D. & GEERTRYDEN, H. H. - Neurologic compplications of aortic surgery. Ann. Surg., 144: 574-610, 1956. [MedLine]

2. BORST, H. G.; WALTERBUSCH, G.; SCHAPS, D. - Extensive aortic replacement using "elephant trunk" prosthesis. Thorac. Cardiovasc. Surgeon, 31: 37-40, 1983.

3. CRAWFORD, E. S. - Thoracoabdominal and abdominal aortic aneurysms involving renal, superior mesenteric and celiac arteries. Ann. Surg., 179: 763-772, 1974. [MedLine]

4. CRAWFORD, E. S.; COSELLI, J. S.; SAFI, H. J. - Partial cardipulmonary bypass, hypothermic circulatory arrest and posterolateral exposure for thoracic aortic aneurysm operation. J. Thorac. Cardiovasc. Surg., 94: 824-827, 1987. [MedLine]

5. CRAWFORD, E. S.; MIZRAHI, E. M.; HESS, K. P.; COSELLI, J. S.; SAFI, H. J.; PATEL, V. M. - The impact of distal aortic perfusion and somatosensory evoked potential monitoring on preservation of paraplegia after aortic aneurysms operation. J. Thorac. Cardiovasc. Surg., 95: 357-367, 1988. [MedLine]

6. CRAWFORD, E. S. & SCHUESSLER, J. S. - Thoracoabdominal and abdominal aortic aneurysms involving celiac, superior mesenteric and renal arteries. World J. Surg., 4: 643-652, 1980.

7. CRAWFORD, E. S.; SNEYDER, D. M.; CHO, G. C.; ROEHM, J. O. F. - Progress in treatment of thoracoabdominal and abdominal aortic aneurysms involving celiac, superior mesenteric and renal arteries. Ann. Surg, 188: 404-422, 1978. [MedLine]

8. CUNNINGHAM, J. N.; LASCHINGER, J. C.; MERKIN, H. A.; NATHAN, I. M.; COLVIN, S.; RAUSOHUFF, J.; SPENCER, F. C. - Measurement of spinal cord ischemia during operations upon the thoracid aorta. Ann. Surg., 196: 285-296, 1982. [MedLine]

9. DeBAKEY, M. E.; CRAWFORD, E. S.; GARRET, H. E.; BEALL, A. C.; HOWELL, J. F. - Surgical considerations in the treatment of aneurysms of thoracoabdominal aorta. Ann. Surg., 162: 650-662, 1965. [MedLine]

10. DeBAKEY, M. E.; CREECH, O.; MORRIS, G. C. - Aneurysm of thoracoabdominal aorta involving the celiac, superior mesenteric and renal arteries: report of four cases treated by ressection and hornograft replacement. Ann. Surg., 144: 549-573, 1956. [MedLine]

11. DRUMMOND, J. C.; ZORNOW, M. H.; DEMBITSKY, W. P. - Spurious identification of critical intercostal arteries by evoked responses during aortic resection. Ann. Thorac. Surg., 44: 79-81, 1987. [MedLine]

12. EDMUNDS, L. H. & FOKMAN, M. J. - Aneurysmoplasty and prosthetic bypass for aneurysms of the descending thoracic and thoracoabdominal aorta. J. Thorac. Cardiovasc. Surg., 52: 395-407, 1967.

13. EDWARDS, W. S. - Thoracoabdominal aortic aneurysms. Surg. Clin. N. Am., 62: 441-448, 1982.

14. ENTHEREDGE, S. N.; YEE, J.; SMITH, J. V.; SCHONBERGER, S.; GOLDMAN, M. J. - Successful resection of a large aneurysm of the upper abdominal aorta and replacement with homograft. Surgery, 38: 1071-1081, 1955. [MedLine]

15. HARDY, J. M.; TIMMIS, H. H.; SALEH, S. J.; HARDIN, W. S. - Thoracoabdominal aortic aneurysm: simplified surgical management with case report. Ann. Surg., 166: 1008-1011, 1967. [MedLine]

16. HUMMEL, B. W. & ROSSI, N. P. - A simple technique for renal protection during repair of complicated aneurysms. Ann. Thorac. Surg., 39: 584-585, 1985. [MedLine]

17. KIRKLIN, J. W. & BARRAT-BOYES, B. G. - Cardiac surgery. New York, John Wiley & Sons, 1986. p. 1493-1524.

18. KOROMPAI, F. L. & HAYWARD, R. H. - Preservation of visceral perfusion during resection of thoracoabdominal aneurysm. Bull. Texas Heart Inst., 2: 349-351, 1975.

19. MASSIMO, C. G.; POMA, A. G.; VILIGIARDI, R. R.; DURANTI, A.; COLUCCI, M.; FAVI, P. P. - Simultaneous total aortic replacement from arch to bifurcation experience with six cases. Texas Heart Inst. J., 13: 147-151, 1986.

20. PAPADOPUOLOS, C. D.; MANOLI, A. M.; SOBEL, S. - Surgical treatment of thoracoabdominal aneurysms. J. Cardiovasc Surg., 12: 456-462, 1971.

21. POKELA, R.; KÄRKÖLÄ, P.; TARKKA, M.; KAIRAMONA, M. I.; LARMI, T. K. I. - Surgery of thoracoabdominal aortic aneurysms. Scand. J. Thorac. Cardiovasc. Surg., 18: 179-189, 1984. [MedLine]

22. SCHUMAKER, H. B. - Innovation in the operative management of the thoracoabdominal aortic aneurysm. Surg. Gynecol. Obstet., 136: 793-794, 1973. [MedLine]

23. SELLE, J. G.; ROBICSECK, F.; DAUGHERTY, H. K.; COOK, J. W. - Thoracoabdominal aortic aneurysms: a review and current status. Ann. Surg., 189: 158-164, 1979. [MedLine]

24. STONEY, R. J. & WYLIE, E. J. - Surgical management of arterial lesions of the thoracoabdominal aorta. Am. J. Surg, 126: 157-164, 1973. [MedLine]

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