Rani rezultati operativnog lecenja torakoabdominalnih aneurizmi Crawford tip IV

Objective: The aim of the study was to present the outcome of surgical treatment of patients with thoracoabdominal aortic aneurysm Crawford type IV, operated on between January 2001 and April 2004. Methods: This study included 42 subsequent patients (40 males, 2 females, age 41-76 years). All patients underwent ultrasonography, angiography, computed tomography or magnetic resonance imaging (MRI). Surgical treatment was performed under combined anesthesia (continuous thoracic epidural analgesia and general endotracheal anesthesia). In two patients thoracophrenolumbotomy was performed at the level of X rib, while others were operated through left lumbotomy after the extra pleural resection of XI rib. We did not perform any spinal cord protection procedures in this type of aneurysm. Reconstruction included interposition of Dacron graft in 20 patients, aortobiiliac bypass in 18, and aortobifemoral bypass in 4 patients with different varieties of visceral branches reimplantation. Results: Thirty - days mortality was 31% (13 patients, two of them intraoperatively). Causes of death were: pulmonary embolism - in 1 patient; hemorrhage - in 2; myocardial infarction - in 4 (two intraoperative); acute renal failure - in 2; multi system organ failure (MSOF) - in 4 patients. Respiratory failure dominated in all cases of MSOF. One patient with acute renal failure had paraplegia also, and that was the only case of neurological complication in whole group. All female patients (2), all patients with ruptured aneurysm (4), acute myocardial infarction (4) and acute renal failure (2) have died. Advanced age (over 70 years) and the need for extensive operative procedure with bifurcated graft use significantly influenced their mortality (p<0.01 and p<0.05 respectively). Conclusions: Surgical treatment of thoracoabdominal aortic aneurysm Crawford IV type was successful in 69% of our patients. There was no need for spinal cord protection measures, and extra peritoneal approach with XI rib resection under the combined anesthesia was preferred.