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Surgical Repair of Ruptured Thoracoabdominal Aortic Aneurysms

Jae S. Cho, MD, Ghassan Abu-Hamad, MD, Robert Y. Rhee, MD and Michel Makaroun, MD
University of Pittsburgh, Pittsburgh, PA

Objective: The purpose of this study was to evaluate the results of open repair for ruptured descending thoracic and thoracoabdominal aortic aneurysm (rTAA).
Methods: A retrospective review identified 47 patients (pts) who presented with non-traumatic, atherosclerotic rTAA from 1996 to 2006. Thirty-seven pts underwent open surgical repair. Correlation matrix and logistic regression model were used to determine prognostic indicators.
Results: The operative mortality rate was 29.7% (11/37) and the 30-day mortality rate 27% (10/37). All but 2 deaths occurred within 24 hours of operation; 7 were intraoperative. Of the 30 pts who survived the initial repair, dialysis dependent renal failure, pulmonary failure requiring tracheostomy, and paraplegia developed in 7 (23%), in 9 (30%) and in 4 pts (13%), respectively. Age and aneurysm extent did not affect the survival rate. Preoperative renal insufficiency (p=.006) and renal artery bypass grafting (p=.02) were associated with postoperative dialysis. In addition to chronic obstructive pulmonary disease (p=.004), large aneurysm diameter (p=.004) was found to correlate with postoperative tracheostomy. Clamp time (p=.01) and renal bypass grafting (p=.01) were predictive of paraplegia, while adjunctive use of left heart bypass, cerebrospinal fluid drain and sequential clamping did not have protective effects against paraplegia.
Conclusions: Direct open repair for rTAA can be achieved with acceptable mortality and morbidity rates. The complication rates in this study appears to be lower than those reported for ruptured infrarenal abdominal aortic aneurysm. Expeditious conduct of the operation with minimal clamp time is essential to assure the best outcome. This series may serve as a reference against which results of current and future endovascular endeavors could be compared