Abstract
A thoraco-abdominal aortic aneurysm is defined by dilatation of the aorta to a diameter that is at least 50%greater than the expected normal diameter at the diaphragmatic hiatus, with varying degrees of thoracic and abdominal extension. Because thoraco-abdominal aortic diameter varies from its most proximal section (just distal to the left subclavian artery) to its most distal section (which includes varying sections of the abdominal aorta), one must assess aortic diameter relative to nearby healthy sections of aortic tissue while accounting for the effects of age, sex, and body size. Thoraco-abdominal aortic aneurysms should be interpreted in the context of their causes, the two most common of which are medial degeneration and aortic dissection. Aneurysms caused by aortic dissection can be further classified in terms of the extent of aortic involvement, acuity, and type of aortic wall disruption. For more than three decades, thoraco-abdominal aortic aneury sm repairs have been classified according to the extent of aortic replacement; the Crawford classification system facilitates risk stratification, helps surgeons plan the surgical approach and select protective adjuncts, and facilitates standardized reporting of results.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Johnston KW, Rutherford RB, Tilson MD et al. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg 1991;13:452–458
Garcier JM, Petitcolin V, Filaire M et al. Normal diameter of the thoracic aorta in adults: a magnetic resonance imaging study. Surg Radiol Anat 2003;25:322–329
Borst HG, Heinemann MK, Stone CD. Surgical treatment of aortic dissection. Churchill Livingstone, New York, 1996
LeMaire SA, Thompson RW. Surgical therapy. In: Creager MA, Loscalzo J, Dzau VS (eds) Vascular medicine: A companion to Braunwald’s heart disease. WB Saunders, Philadelphia, 2006
Coady MA, Rizzo JA, Elefteriades JA. Pathologic variants of thoracic aortic dissections: penetrating atherosclerotic ulcers and intramural hematomas. Cardiol Clin 1999;17:637–657
Ganaha F, Miller DC, Sugimoto K et al. Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer: a clinical and radiological analysis. Circulation 2002;106:342–348
LeMaire SA, Carter SA, Volguina IV et al. Spectrum of aortic operations in 300 patients with confirmed or suspected Marfan syndrome. Ann Thorac Surg 2006;81:2063–2078
LeMaire SA, Pannu H, Tran-Fadulu V et al. Severe aortic and arterial aneurysms associated with a TGFBR2 mutation. Nat Clin Pract Cardiovasc Med 2007;4:167–171
Milewicz DM, Dietz HC, Miller DC. Treatment of aortic disease in patients with Marfan syndrome. Circulation 2005;111:e150–e157
Loeys BL, Schwarze U, Holm T et al. Aneurysm syndromes caused by mutations in the TGF-β receptor. N Engl J Med 2006;355:788–798
Schwill S, LeMaire SA, Green S Y et al. Endovascular repair of thoracic aortic pseudoaneurysms and patch aneurysms. J Vasc Surg (in press)
Crawford ES, Crawford JL, Safi HJ et al. Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients. J Vasc Surg 1986;3:389–404
Coselli JS, Bozinovski J, LeMaire SA. Open surgical repair of 2286 thoracoabdominal aortic aneurysms. Ann Thorac Surg 2007;83:S862–S864
Safi HJ, Miller CCIII. Spinal cord protection in descending thoracic and thoracoabdominal aortic repair. Ann Thorac Surg 1999;67:1937–1939
Estrera AL, Miller CC III, Huynh TT et al. Neurologic outcome after thoracic and thoracoabdominal aortic aneurysm repair. Ann Thorac Surg 2001;72:1225–1231
Huh J, LeMaire SA, Coselli JS. Descending and thoracoabdominal aortic aneurysms. In: Cohn LH (ed) Cardiac surgery in the adult. The McGraw-Hill Companies, New York (in press)
Svensson LG, Crawford ES, Hess KR et al. Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg 1993;17:357–368
LeMaire SA, Miller CC III, Conklin LD et al. A new predictive model for adverse outcomes after elective thoracoabdominal aortic aneurysm repair. Ann Thorac Surg 2001;71:1233–1238
Coselli JS, LeMaire SA, Conklin LD et al. Morbidity and mortality after extent II thoracoabdominal aortic aneurysm repair. Ann Thorac Surg 2002;73:1107–1116
Etz CD, Di Luozzo G, Bello R et al. Pulmonary complications after descending thoracic and thoracoabdominal aortic aneurysm repair: predictors, prevention, and treatment. Ann Thorac Surg 2007;83:S870–S876
Jones MM, Akay M, Murariu D et al. Safe aortic arch clamping in patients with patent internal thoracic artery grafts. Ann Thorac Surg 2010;89:e31–e32
MacArthur RG, Carter SA, Coselli JS et al. Organ protection during thoracoabdominal aortic surgery: rationale for a multimodality approach. Semin Cardiothorac Vasc Anesth 2005;9:143–149
Coselli JS, LeMaire SA. Tips for successful outcomes for descending thoracic and thoracoabdominal aortic aneurysm procedures. Semin Vasc Surg 2008;21:13–20
Köksoy C, LeMaire SA, Curling PE et al. Renal perfusion during thoracoabdominal aortic operations: cold crystalloid is superior to normothermic blood. Ann Thorac Surg 2002;73:730–738
Coselli JS, LeMaire SA, Köksoy C et al. Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: results of a randomized clinical trial. J Vasc Surg 2002;35:631–639
Cinà CS, Abouzahr L, Arena GO et al. Cerebrospinal fluid drainage to prevent paraplegia during thoracic and thoracoabdominal aortic aneurysm surgery: a systematic review and meta-analysis. J Vasc Surg 2004;40:36–44
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag Italia
About this chapter
Cite this chapter
Wu, D., LeMaire, S.A., Coselli, J.S. (2011). Definitions and Classifications. In: Chiesa, R., Melissano, G., Zangrillo, A. (eds) Thoraco-Abdominal Aorta. Springer, Milano. https://doi.org/10.1007/978-88-470-1857-0_2
Download citation
DOI: https://doi.org/10.1007/978-88-470-1857-0_2
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-1856-3
Online ISBN: 978-88-470-1857-0
eBook Packages: MedicineMedicine (R0)