Thoracoabdominal Aortic Aneurysm Repair

Aortic Aneurysm Chest Xray

Miller III, Samer Koussayer Thoracoabdominal aortic aneurysm (TAA) involves the portion of the aorta located in the chest and abdomen from the left subclavian artery to the iliac bifurcation. Because the many aspects of aneurysm graft replacement can affect multiple organs with potentially severe side effects, the operation has always been a formidable endeavor. Surgeons first performed successful TAA graft replacement half a century ago and since then morbidity rates...

Info

Pararenal aortic aneurysm reconstructed with a fish-mouth proximal anastomosis, using a polyethylene aortic graft. Fig. 15.3. Pararenal aortic aneurysm reconstructed with a fish-mouth proximal anastomosis, using a polyethylene aortic graft. review of 518 Type IV thoracoabdominal aneurysm repairs, published in 5 large series, Panneton and Hollier reported an average mortality of 7 , ranging from 0-28 . Mortality in more recent selected series, reviewed at the end of this chapter, has...

Expansion Of Paod

Claudication has been associated with an increased risk of abdominal aneurysm in some reports, but results varied depending on the definition of aneurysm. Allardice et al compared patients with PAOD to controls with similar smoking habits who had (bronchogenic carcinoma). The frequency of abdominal aneurysms was higher in patients with PAOD, reaching 17 in males. A criticism of this study is that it also included patients with peripheral aneurysms, known by its association with abdominal...

Asymptomatic Gallstones The Case for a Combined Approach

This is one of the more common scenarios of combined disease, due to the relative frequency of gallstones in the aneurysm population. The near universal use of ultrasound and or CT scanning in the diagnosis of aneurysm disease often provides this information to the surgeon preoperatively. When gallstones are diagnosed before aortic operation, the surgeon should attempt to elicit any symptoms of biliary tract disease from the patient. This may not always be initially apparent, since the symptoms...

Evaluation

A careful history and physical examination will frequently provide the clinician with considerable information. In general, risk factors for aortoiliac occlusive disease parallel those seen for other atherosclerotic lesions elderly, male, diabetes, hypertension, tobacco abuse . In contrast, however, nearly half of all patients with limited, localized aortoiliac disease are women. Women patients tend to have more focal disease, are active smokers and present at a younger age than their male...

Transperitoneal Exposure of the Abdominal Aorta at the Diaphragmatic Hiatus

Exposure of the supraceliac aorta at the diaphragmatic hiatus is life saving for early control of exigent hemorrhage in the case of ruptured abdominal aortic aneurysm. It is also useful for temporary control of the aorta during repair of aortocaval or aortoenteric fistulae and infected aortic grafts. Less frequently, this exposure is suitable for revascularization of the celiac trunk and its proximal branches or the superior mesenteric artery. This exposure, through the lesser sac, is...

Guidewire Traversal of Stenoses and Occlusion

Most aortoiliac stenoses are easily crossed using standard coil-spring type angiographic wires. In many cases a shaped catheter we prefer a hockey-stick shape in most cases can be used to steer through an irregular arterial stenosis. Angledtip hydrophilic guidewires are also very popular for negotiating tortuous stenoses, but they also tend to dissect subintimally more often than other wires and therefore must be used carefully. Another alternative is to use a tapered, high torque soft-tip...

Ruptured Abdominal Aortic Aneurysm

Abdominal aortic aneurysm AAA is a degenerative atherosclerotic condition characterized by progressive dilation of the abdominal aorta. In one-third to one-half of patients it expands and leads ultimately, if not managed appropriately, to rupture and exsanguination. The characteristic patient with an AAA is an elderly male with a smoking history such patients commonly are afflicted with coronary, cerebrovascular and other peripheral manifestations of atherosclerosis as well.1 All but 2 of such...

Occlusive Disease of the Upper Abdominal Aorta

Stoney Occlusive disease of the primary paired and unpaired branches of the upper abdominal aorta exhibits a wide variety of clinical presentations from silent but insidious renal failure to fatal intestinal infarction. This chapter will review the patho-physiology, clinical presentation, diagnosis and treatment of these conditions. Pathophysiology and Clinical Presentation An embolus to the superior mesenteric artery is the most frequent 50 cause of acute...

Extraperitoneal Exposure of the External Iliac Arteries

This exposure begins with an oblique incision in the lower quadrant of the abdomen on the side of involved iliac artery occlusive disease. It is wise to start the incision near the pubic tubercle with extension obliquely lateral, staying medial to the anterior superior iliac spine of the pelvis. The external oblique aponeurosis is opened in the direction of its fibers and the incision continued into the fleshy portion of this muscle. The internal oblique and transversus abdominus muscles are...

Surgical Treatment of Infected Aortic Aneurysms

Ruptured Mycotic Aneurysm

In 1885 Sir William Osler1 presented a comprehensive analysis of infected aneu-rysms and coined the term mycotic aneurysm specifically to refer to patients who presented with infected aneurysms secondary to endocarditis. Since then, however, the term has been used to refer to infected aneurysms regardless of pathogenesis. The fact that other sources of infection could also cause infection in the arterial wall was suggested by Stangel and Wolfed in 1923,2 describing 30 of 213 patients in whom...

Retroperitoneal Exposure of the Abdominal Aorta and Its Branch Vessels

Transperitoneal aortic exposure is generally regarded as the standard operative approach to the abdominal aorta. However, retroperitoneal aortic exposure has gained wider acceptance among vascular surgeons as it affords a more direct route to the aorta and facilitates complex aortic reconstruction above the level of the renal arteries. We and others have demonstrated that in comparison to transperitoneal aortic exposure, the retroperitoneal approach is associated with decreased perioperative...

Epidemiology of Aortic Aneurysmal Disease

Prevalence Aortic Dissection

Oderich, Kiran Bhirangi Aneurysm of the aorta is a common disease, representing 83 of all noncerebral aneurysms diagnosed in the United States.1 Although necropsy studies indicated a predominance of thoracic aortic aneurysms in the beginning of the century, this figure has dramatically changed since then. This is probably due to the loss of syphilis as an etiologic factor and an increase in degenerative atherosclerotic aneurysms of the abdominal aorta. In 1994,...