Fate of the visceral aortic patch after thoracoabdominal aortic repair

Yamume Tshomba, G. Melissano, E. Civilini, F. Setacci, R. Chiesa

Research output: Contribution to journalArticle

Abstract

Objective. To analyse the fate of a visceral aortic patch (VAP) in patients that underwent thoracoabdominal aortic aneurysm (TAAA) repair. Methods. We reviewed 204 consecutive patients (158 M, 46 F) treated for TAAA between 1988 and 2004. We performed VAP in 182 cases. Among the 149 survivors at 6 months, we followed 138 cases, mean follow-up 7 years (range 0.6-16 years). The mean graft diameter we used was 29 mm (range 24-34 mm) from 1988 to 1999 (83 patients), and 21.7 mm (range 16-24 mm) from 2000 to 2003 (55 patients). In 23% of cases we performed a separate bypass to the left renal artery. Results. We observed 16 (12%) VAP dilatations (5 cm) and one VAP pseudoaneurysm, at a mean time of 6 years after atherosclerotic TAAA was atherosclerotic repair. There were no VAP dilatations/aneurysms in the group of patients with separate left renal revascularization. Five VAP aneurysms were treated electively. In four cases the operation was performed with thoracophrenolaparotomy, in one case with a bilateral subcostal laparotomy. In all cases the visceral aorta was re-grafted. Reimplantation of a single undersized VAP was performed in one case, separate revascularization of visceral arteries was performed in the other four cases. Selective intraoperative hypothermic perfusion of visceral and renal arteries was used in all the patients. There was 1 perioperative death; 2 patients with preoperative renal failure required dialysis. The last VAP aneurysm has remained asymptomatic and stable at annual CT surveillance. The VAP pseudoaneurysm was successfully treated with an emergency thoracophrenolaparotomy and refashioning the left side suture line. Conclusions. Aneurysm of VAP is not uncommon in the patients operated on using larger grafts with a single VAP that includes the LRA (7.4%, 5/67 cases). Its treatment carries significant morbidity and mortality.

Original languageEnglish
Pages (from-to)383-389
Number of pages7
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume29
Issue number4
DOIs
Publication statusPublished - Apr 2005

Keywords

  • Aortic reoperation
  • Complication
  • Reintervention
  • Thoracoabdominal aneurysm
  • Visceral patch

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Surgery

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