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 PVSS1. Open Surgical Techniques for Repair of Type 3 and 4 Thoracoabdominal Aortic Aneurysms: Is One Better Than the Others?

Muhammad Ali A. Rana, Peter Gloviczki, Harbuzariu Catalin, Audra Duncan, Manju Kalra, Gustavo S. Oderich, Mark D. Fleming, Thomas C. Bower
Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
OBJECTIVES: Various techniques are used for repair of thoracoabdominal aortic aneurysms (TAAAs). This study compares outcomes following repair of Type 3 and 4 TAAAs using 3 different techniques at a tertiary care institution over the same time period.
METHODS: One hundred twenty-one consecutive patients (83 male, 38 female) with 52 Type 3 and 69 Type 4 TAAAs underwent elective repair between 1999 and 2011. Group 1 (65 patients) – clamp-and-sew technique; Group 2 (31 patients) – left atrio femoral bypass; Group 3 (25 patients) – visceral branching technique of Ballard. There was no difference in cardiac and pulmonary risk factors, aneurysm size or presence of dissection; 12% of Group 3 was on dialysis pre-operatively (vs. 2% and 0% in groups 1 and 2). Eighty-four percent of the patients had perioperative spinal fluid drainage.
RESULTS: Procedure duration was longest in Group 3 (9.1 vs. 7.7 and 5.7 hours, for 1 and 2; p<0.001) but transfusion requirement was largest in Group 2 (3.5 liters vs. 1.7 and 2.1, for 1 and 3). Mean ICU and hospital stays were the same (9, 10 and 8 days: p=0.82; 18, 20 & 18 days: p=0.76). Cardiac (p=0.82), respiratory (p=0.43) and renal (p=0.07) complications were not different between groups. Spinal cord injury occurred in 6%, and it was not different among groups (3%, 10% and 8%; p=0.21). Thirty-day mortality was 6.6%, not different in groups 1-3 (6%, 10%, 4%; p=0.68). Median follow-up was 45 (±42) months with median survival of 84, 73 and 40 months in Groups 1-3, respectively (p=0.49). Estimated overall survival at 5 and 10 years was 65% and 23%.
CONCLUSIONS: For repair of Types 3 and 4 TAAAs, the Ballard aortic branching technique had the longest duration, but the clamp-and-sew technique had the lowest transfusion requirements. Complications, early and late mortality, and spinal cord injury were the same using the clamp-and-sew technique, atrio femoral bypass or the Ballard techniques.
AUTHOR DISCLOSURES: T. C. Bower: Nothing to disclose; H. Catalin: Nothing to disclose; A. Duncan: Nothing to disclose; M. D. Fleming: Nothing to disclose; P. Gloviczki: Nothing to disclose; M. Kalra: Nothing to disclose; G. S. Oderich: Cook Medical, Consulting fees or other remuneration (payment); Gore, Consulting fees or other remuneration (payment); M. A. Rana: Nothing to disclose
Posted March 2013

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