ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Sacrification and total resection of intercostal arteries in distal aortic surgery
Anıl Z. Apaydın, Fatih İslamoğlu, Hakan Posacıoğlu, Tanzer Çalkavur, Tahir Yağdı, Yüksel Atay, Çağatay Engin, Fatih Ayık, İsa Durmaz
Ege Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Anabilim Dalı, İzmir
Background: We evaluated risk factors for morbidity and mortality in patients who underwent graft replacement by intercostal artery sacrification and total resection for descending or thoracoabdominal aortic aneurysms.

Methods: Forty-seven patients (39 males, 8 females; mean age 52±12 years) underwent surgical repair for descending (n=31) or thoracoabdominal (n=16) aortic aneurysms. Replacement of the descending aorta involved the entire segment, the proximal and distal segments in 12, 17, and two patients, respectively. Thoracoabdominal aortic aneurysms were Crawford type I (n=6), type II (n=2), type III (n=6), and type V (n=2). Perfusion methods were hypothermic circulatory arrest in 22 patients and atriofemoral bypass in 12 patients. Simple clamping was used in 13 patients.

Results: Overall mortality and mortality in elective cases were 14.9% (7/47) and 7.7% (3/39), respectively. Concerning thoracoabdominal aortic aneurysms, one patient died of multiorgan failure following development of paraplegia, two patients with coronary artery disease (CAD) and ruptured aneurysms died of myocardial infarction and heart failure. Four patients with descending aortic aneurysms died due to stroke (n=2) and multiorgan failure (n=2). Morbidity included temporary paraparesis (n=1), dialysis (n=5), and tracheostomy (n=2). Univariate analysis showed emergent operation, blood transfusion of more than five units, severe CAD, sacrification of more than 10 pairs of intercostal arteries, and the presence of aortic dissection as significant risk factors for mortality. In multivariate analysis, emergent operation and severe CAD were independent risk factors for mortality. In addition, distal ischemia of more than 70 minutes was a significant risk factor for the occurrence of any adverse event.

Conclusion: In patients with descending or thoracoabdominal aortic aneuryms, elective surgical interventions can be performed with acceptable morbidity and mortality. Emergent operations and the presence of severe CAD increase mortality in this patient group.

Keywords : Aortic aneurysm, abdominal/surgery; aortic aneurysm, thoracic/surgery; postoperative complications; risk factors
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