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Surgery for descending thoracic aortic anastomotic aneurysms with a temporary external bypass method

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Abstract

The surgical treatment of descending thoracic aortic anastomotic aneurysms is technically challenging. The purpose of this study was to evaluate the use of a temporary external bypass method as an intraoperative measure in the surgical treatment of anastomotic aneurysms of the descending thoracic aorta. An analysis of five consecutive patients who had undergone surgery for a collective seven descending thoracic aortic anastomotic aneurysms in our university hospital over a period of 14 years was conducted. A temporary bypass technique was used as an intraoperative measure in all the operations, four of which were performed with a right axillary to left external iliac artery bypass, while other sites were used in the remaining three. Systemic heparinization was able to be avoided in six operations and was markedly reduced in the remaining one. Although the major postoperative complication was coagulated hemothorax after six procedures, all patients recovered well and are still alive after a mean follow-up period of 8.2±1.5 (SEM) years. The results of this analysis led us to conclude that our temporary bypass method for treating descending thoracic aortic anastomotic aneurysm prevented the risks of anticoagulant administration for circulatory support, which contributed to the success of the operation. This method can be used as adjunct treatment for anastomotic aneurysms in the descending thoracic aorta.

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References

  1. Szilagyi DE, Smith RF, Elliott JP, Hageman JH, Dall’Olmo CA (1975) Anastomotic aneurysms after vascular reconstruction: problems of incidence, etiology and treatment. Surgery 78:800–816

    CAS  PubMed  Google Scholar 

  2. Favre JP, Gournier JP, Adham M, Rosset E, Barral X (1994) Aortobronchial fistula: report of three cases and review of the literature. Surgery 115:264–270

    CAS  PubMed  Google Scholar 

  3. Bogey WMJ, Thomas JH, Hermreck AS (1992) Aortoesophageal fistula: report of a successfully managed case and review of the literature. J Vasc Surg 16:90–95

    Article  PubMed  Google Scholar 

  4. Ishizaki Y, Tada Y, Takagi A, Sato O, Takayama Y, Shirakawa M, Idezuki Y (1990) Aortobronchial fistula after an aortic operation. Ann Thorac Surg 50:975–977

    Article  CAS  PubMed  Google Scholar 

  5. Egami J, Tada Y, Takagi A, Sato O, Idezuki Y (1992) False aneurysm as a late complication of division of a patent ductus arteriosus. Ann Thorac Surg 53:901–902

    Article  CAS  PubMed  Google Scholar 

  6. Sato O, Tada Y, Miyata T, Shindo S (1992) False aneurysms after aortic operations. J Cardiovasc Surg Torino 33:604–608

    CAS  PubMed  Google Scholar 

  7. Crawford ES, Walker HSd, Saleh SA, Normann NA (1981) Graft replacement of aneurysm in descending thoracic aorta: results without bypass of shunting. Surgery 89:73–85

    CAS  PubMed  Google Scholar 

  8. Culliford AT, Ayvaliotis B, Shemin R, Colvin SB, Isom OW, Spencer FC (1983) Aneurysms of the descending aorta. Surgical experience in 48 patients. J Thorac Cardiovasc Surg 85:98–104

    CAS  PubMed  Google Scholar 

  9. Verdant A, Cossette R, Page A, Baillot R, Dontigny L, Page P (1995) Aneurysms of the descending thoracic aorta: three hundred sixty-six consecutive cases resected without paraplegia. J Vasc Surg 21:385–390

    Article  CAS  PubMed  Google Scholar 

  10. Crawford ES, Stowe CL, Crawford JL, Titus JL, Weilbaecher DG (1984) Aortic arch aneurysm. A sentinel of extensive aortic disease requiring subtotal and total aortic replacement. Ann Surg 199:742–752

    Article  CAS  PubMed  Google Scholar 

  11. Kouchoukos NT, Lell WA, Karp RB, Samuelson PN (1979) Hemodynamic effects of aortic clamping and decompression with a temporary shunt for resection of the descending thoracic aorta. Surgery 85:25–30

    CAS  PubMed  Google Scholar 

  12. Cartier R, Orszulak TA, Pairolero PC, Schaff HV (1990) Circulatory support during crossclamping of the descending thoracic aorta. Evidence of improved organ perfusion. J Thorac Cardiovasc Surg 99:1038–1046

    CAS  PubMed  Google Scholar 

  13. Gott VL (1972) Heparinized shunts for thoracic vascular operations. Ann Thorac Surg 14:219–220

    Article  CAS  PubMed  Google Scholar 

  14. Donahoo JS, Brawley RK, Gott VL (1977) The heparin-coated vascular shunt for thoracic aortic and great vessel procedures: a ten-year experience. Ann Thorac Surg 23:507–513

    Article  CAS  PubMed  Google Scholar 

  15. Carlson DE, Karp RB, Kouchoukos NT (1982) Surgical treatment of aneurysms of the descending thoracic aorta: an analysis of 85 patients. Ann Thorac Surg 35:58–69

    Article  Google Scholar 

  16. Molina JE, Cogordan J, Einzig S, Bianco RW, Rasmussen T, Clack RM, Borgwardt B (1985) Adequacy of ascending aortadescending aorta shunt during cross-clamping of the thoracic aorta for prevention of spinal cord injury. J Thorac Cardiovasc Surg 90:126–136

    CAS  PubMed  Google Scholar 

  17. Olivier HF, Jr, Maher TD, Liebler GA, Park SB, Burkholder JA, Magovern GJ (1984) Use of the BioMedicus centrifugal pump in traumatic tears of the thoracic aorta. Ann Thorac Surg 38:586–591

    Article  PubMed  Google Scholar 

  18. von Segesser LK, Weiss BM, Garcia E, von Felten A, Turina MI (1992) Reduction and elimination of systemic heparinization during cardiopulmonary bypass. J Thorac Cardiovasc Surg 103:790–799

    Google Scholar 

  19. Stranahan A, Alley RD, Sewell WH, Kausel HW (1955) Aortic arch resection and grafiting for aneurysm employing an external shunt. J Thorac Surg 29:54–65

    CAS  PubMed  Google Scholar 

  20. Tada Y, Kamiya K, Shindo S, Suzuki O, Ishimoto T, Takagi A, Sato O, Miyata T, Furuya T, Nobori M (1995) Surgical management of atherosclerotic aneurysms of the distal aortic arch using a temporary bypass graft method. Yamanashi Med J 10:111–119

    Google Scholar 

  21. Kwaan JH, Humphrey R, Connolly JE(1981) Extrapleural and extraperitoneal staged technique in successful management of complicated thoracic anastomotic aneurysm. Surgery 90:554–558

    CAS  PubMed  Google Scholar 

  22. Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP (1995) Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 331:1729–1734

    Article  Google Scholar 

  23. Mitchell RS, Dake MD, Sembra CP, Fogarty TJ, Zarins CK, Liddel RP, Miller DC (1996) Endovascular stent-graft repair of thoracic aortic aneurysms. J Thorac Cardiovasc Surg 111:1054–1062

    Article  CAS  PubMed  Google Scholar 

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Miyata, T., Sato, O., Deguchi, Jo. et al. Surgery for descending thoracic aortic anastomotic aneurysms with a temporary external bypass method. Surg Today 29, 129–136 (1999). https://doi.org/10.1007/BF02482237

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  • DOI: https://doi.org/10.1007/BF02482237

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