GRAFT REPLACEMENT OF ANEURYSM IN DESCENDING THORACIC AORTA - RESULTS WITHOUT BYPASS OR SHUNTING

  • 1 January 1981
    • journal article
    • research article
    • Vol. 89  (1) , 73-85
Abstract
Patients [112] with aneurysms confined to the thoracic aortic segment, bounded above by the left subclavian artery and below by the diaphragm, were treated without shunts or bypass. The incidence of paraplegia and the survival rate in this group were 0.9 and 91%, respectively. There were 89 men and 25 women in the series whose ages ranged from 22-87 yr with an average age of 61. All types of aneurysms were represented. Arteriosclerosis and dissection were the most common causes. The extent of aneurysm was variable, but most of the descending thoracic aorta was involved in more than half the cases. Associated diseases were present in 77% of cases. Operation consisted of aneurysmal replacement using inclusion technique with cardiac hemodynamics controlled by vasodilators and fluid replacement. During the past 4 yr, proximal blood pressure was controlled with nitroprusside. Cardiovascular hemodynamics, blood gases, electrolytes and plasma osmolarity were monitored extensively and frequently to achieve the most desirable physiologic response to aortic clamping and operation. During this time, 69 patients were treated. There were 4 (6%) deaths. None developed paraplegia or renal failure. Concomitant subclavian artery clamping was employed in 34 of these patients and in 22 additional patients with distal arch lesions. None in either group developed paraplegia. This indicated the safety of temporary subclavian artery occlusion. Death, both early and late, was due to a number of causes, but rupture of another aneurysm was the most common. This emphasizes the value of concomitant operation in patients with multiple aneurysms and careful follow-up in all patients.

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