Thoracoabdominal and abdominal aortic aneurysms involving celiac, superior mesenteric, and renal arteries

Abstract

Abstract This is a report of surgical treatment of 138 patients with thoracoabdominal aortic aneurysms and aneurysms of the abdominal aorta from which the visceral vessels arise. The patients are divided into 6 groups according to location and extent of aneurysm. Group I (16 patients) involved most of the descending thoracic aorta and the upper abdominal aorta down to the celiac axis. Group II (1 patient) involved all of the aorta except the proximal ascending aorta. In Group III there were 47 patients in whom the aneurysm involved most or all of the descending thoracic and abdominal aorta. In Group IV (31 patients) the aneurysm involved the distal thoracic aorta and part or all of the abdominal aorta. Group V (28 patients) involved either the upper or all of the abdominal aorta, and in Group VI (15 patients) the aneurysm was infrarenal in location but involved the renal arteries. Treatment was by the graft inclusion technique with reattachment of branch vessels by anastomosis directly to openings made in the graft in most cases. Intercostal and lumbar arteries were reattached in some patients in Groups II and III. Aortic and renal occlusion times varied from 15 to 155 minutes. Of the 138 patients in the series, 125 (91%) survived. Transient renal insufficiency occurred in 7 patients. Death occurred in 3 other patients from renal failure, 1 of whom was on chronic hemodialysis. Paraplegia occurred in 12 patients, all submitted to extensive replacements. Intercostal and lumbar artery reattachment reduced the incidence of this problem by 50%. In the survivors, paraplegia was mild to moderate and transient in 4 and severe in 4. All of the latter are now self‐sufficient. The 2 men with this problem are gainfully employed.