Between 1987 and 1994, 21 patients were treated surgically for aortic aneurysm involving the thoracoabdominal aorta. There were ll males and 10 females, and their age ranged from 20 to 67 years old and mean age was 41.5 years.
Many complained of back pain, chest pain or discomfort, and flank pain, but three patients were asymptomatic. 15 patients had chronic dissection(71.4%) and 6 had nondissecting fusiform or saccular aneurysm(28.5%), and of those 15 patients with
chronic
dissection, 6(28.5%) had atherosclerosis associated with hypertension, 5(23.8%) were Marfan syndrome, and 2(9.5%) were associated with pregnancy. The diameter of an aneurysm ranged from 6cm, and their extent was classified as type I in 7(33.3%),
type II
in 8(38.1%), type III in 3(14.3%), and type IV in 3(14.3%) patients based on Crawford classification for TAAA.
Diseased aorta was replaced with artificial vascular graft in all but one patient. In whom the aortic tear site due to pseudoaneurysm was closed by primary suture. For the spinal cord protection during the operation, we used partial
cardiopulmonary
bypass(FV-FA or PA-FA bypass)in 12 patients(57.1%), Biopump(LA-FA bypass) in 4(19.0%), total circulartory arrest and CPB in 2(9.5%), Gott's heparinized shunt in l(4.7%), and simple aortic cross clamping in 2(9.5%).
The most common complication after the operation was hoarseness due to unilateral vocal cord palsy which occured in 5 patients (23.8%), and the next common complication was wound infection in 4 patients(19.0%), paraplegia in 2 patients (9.5%),
chylothorax in l patient(4.7%). The hospital mortality rate was 9.5%(2deaths), and there was no late death.
Our experience shows that the graft replacement of TAAA had reasonable rate of mortality, low rate of serious complication, and provided good post operative state of the patients, and since the thoracoabdominal aortic operation is not a high
risky
procedure anymore, we recommend a radical operation for the indicated patients.
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