Patient selection for open thoracoabdominal aneurysm repair.

Abstract

The great Swiss surgeon Theodor Kocher [1841-1917] once said: “A surgeon is a doctor who can operate and who knows when not to” (1). Given the major impact of thoracoabdominal aortic replacement on human physiology, not to mention pre-existing co-morbidities and potential postoperative complications, it is absolutely mandatory to select operative candidates with great care for this intervention in order to achieve success. In each individual patient the operative risks have to be balanced against other treatment possibilities varying from medical therapy with antihypertensive drugs to the contemporary endovascular or hybrid treatment options. With improving diagnostic possibilities on the one hand and an aging population on the other hand, more and more patients with limited physiologic reserve are being referred for possible treatment. Therefore the decision to intervene, either with conventional open surgery, endovascular procedure or a combination of both, should be based on a predicted operative risk that is lower than the risk of optimal medical management alone. It is the clinical task of the surgeon and anaesthesiologist to select those candidates for whom the operative risks are justified. Objective selection criteria like those accepted for aneurysms of the thoracic aorta (2) could be of great value for this together with solid clinical judgment.