Surgical Treatment Of Thoracic Aneurysms Research Articles

Aneurismas de la aorta toracoabdominal. Indicaciones de tratamiento. Cirugía abierta

Open surgical treatment of thoracic aneurysms is a great challenge for surgeons, anaesthetists and perfusionists. It is a very aggressive procedure, dealing with a high number of uncommon variables and is usually non-standardised in this area, due to its low incidence. The aim of this article is to conduct a review of current indications of treatment of thoracoabdominal aneurysms and to present the open surgery approach, anatomical references, and the most usual and reliable techniques for surgery and perfusion. Step-by-step planning for the intervention is also explained, as well as the strategies for spine and visceral protection. Finally, results for this surgery and future alternatives are discussed.

Aggressive surgical strategy should be used for the treatment of thoracic aortic disease in patients with end-stage renal disease

Surgery for disease of the thoracic artery in patients with end-stage renal disease (ESRD) depending on hemodialysis (HD) tends to be avoided because of its high risk. However, considering that the average survival duration after HD induction is increasing, the adequacy of aggressive surgical treatment of thoracic aneurysms was investigated. Seventeen consecutive surgeries for 16 patients with ESRD with disease of the thoracic aorta performed between 1998 and 2008 were analyzed retrospectively. As an intraoperative renal replacement therapy, prior to 2001, HD was performed in six cases and, after 2002, continuous hemodiafiltration (CHDF) was performed in nine cases. In two cases, no renal replacement therapy was performed during surgery. No operative and hospital mortality occurred, despite challenging indications for surgery like emergency setting (52.5%), history of previous aortic surgery (41.2%) and aortic arch surgeries (58.8%). The five-year survival rate was 62.9%. Median follow-up was 38.8 months (1-117.6). According to this excellent outcome, surgical strategy for ESRD patients with disease of the thoracic aorta should be more aggressive than currently indicated because surgery can be safely performed by means of appropriate application of intraoperative HD or CHDF in order to give sufficient amounts of blood products and manage the water and electrolyte balance.

Transpericardial inferior vena caval cannulation in thoracic aorta operations

Surgical treatment of thoracic aneurysms is frequently performed with the aid of partial cardiopulmonary bypass. When profound hypothermia and circulatory arrest are employed, inadequate venous drainage may represent a major problem. We herein describe a technique of inferior vena caval cannulation that allows steady performance when high pump flows are imposed.