Descending Thoracic and Thoracoabdominal Aortic Aneurysms

  • Konstadinos A. PlestisEmail author
  • Oleg I. Orlov
  • Vishal N. Shah
  • Robert J. Meisner
  • Cinthia P. Orlov
  • Serge SicouriEmail author


Descending thoracic (DTAA) and thoracoabdominal aortic aneurysms (TAAA) are lethal diseases requiring urgent attention. Progress in cerebral, spinal cord, and visceral protection during complex DTAA and TAAA repair has led to a significant decrease in morbidity and mortality. This chapter focuses on critical steps and adjunctive techniques to minimize morbidity and mortality after open repair.


Cerebrospinal fluid drainage Deep hypothermic circulatory arrest Descending thoracic aortic aneurysms Distal aortic perfusion Thoracoabdominal aortic aneurysms 

Supplementary material

Video 56.1

Type II TAAA repair using deep hypothermic circulatory arrest and retrograde cerebral perfusion (AVI 182179 kb)

Video 56.2

Type V TAAA repair (AVI 233875 kb)

Video 56.3

Ascending aorta cannulation (AVI 15370 kb)

Video 56.4

Type III TAAA repair with reimplantation of T9 intercostal arteries (AVI 212504 kb)


  1. 1.
    Clouse WD, Hallett JW Jr, Schaff HV, Gayari MM, Ilstrup DM, Melton LJ III. Improved prognosis of thoracic aortic aneurysms: a population-based study. JAMA. 1998;280:1926–9.CrossRefGoogle Scholar
  2. 2.
    Olsson C, Thelin S, Ståhle E, Ekbom A, Granath F. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation. 2006;114:2611–8.CrossRefGoogle Scholar
  3. 3.
    Elefteriades JA, Farkas EA. Thoracic aortic aneurysm. Clinically pertinent controversies and uncertainties. J Am Coll Cardiol. 2010;55:841–57.CrossRefGoogle Scholar
  4. 4.
    Hiratzka LF, Bakris GL, Beckman JA, et al. ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. J Am Coll Cardiol. 2010;55:e27–e129.CrossRefGoogle Scholar
  5. 5.
    Coselli JS, LeMaire SA, Preventza O, et al. Outcomes of 3309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg. 2016;151:1323–37.CrossRefGoogle Scholar
  6. 6.
    Greenberg RK, Lu Q, Roselli EE, et al. Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair: a comparison of endovascular and open techniques. Circulation. 2008;118:808–17.CrossRefGoogle Scholar
  7. 7.
    Bavaria JE, Appoo JJ, Makaroun MS, Verter J, Yu ZF, Mitchell RS. Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: a multicenter comparative trial. J Thorac Cardiovasc Surg. 2007;133:369–77.CrossRefGoogle Scholar
  8. 8.
    Conway AM, Sadek M, Lugo J, Pillai JB, Pellet Y, Panagoploulos G, Plestis K. Outcomes of open surgical repair for chronic type B aortic dissections. J Vasc Surg. 2014;59:1217–23.CrossRefGoogle Scholar
  9. 9.
    Ayaz S, Ayaz UY. Detection of retroaortic left renal vein and circumaortic left renal vein by PET/CT images to avoid misdiagnosis and support possible surgical procedures. Hell J Nucl Med. 2016;19:135–9.PubMedGoogle Scholar
  10. 10.
    Sadek M, Abjigitova D, Pellet Y, Rachakonda A, Panagopoulos G, Plestis K. Operative outcomes after open repair of descending thoracic aortic aneurysms in the era of endovascular surgery. Ann Thorac Surg. 2014;97:1562–7.CrossRefGoogle Scholar
  11. 11.
    Etz CD, Halstead JC, Spielvogel D, Shahani R, Lazala R, Homann TM, et al. Thoracic and thoracoabdominal aneurysm repair: is reimplantation of spinal cord arteries a waste of time? Ann Thorac Surg. 2006;82:1670–7.CrossRefGoogle Scholar
  12. 12.
    Conrad MF, Crawford RS, Davison JK, Cambria RP. Thoracoabdominal aneurysm repair: a 20-year perspective. Ann Thorac Surg. 2007;83:S856–61.CrossRefGoogle Scholar
  13. 13.
    Schepens MA, Heijmen RH, Ranschaert W, Sonker U, Morshuis WJ. Thoracoabdominal aortic aneurysm repair: results of conventional open surgery. Eur J Vasc Endovasc Surg. 2009;37:640–5.CrossRefGoogle Scholar
  14. 14.
    Estrera AL, Jan A, Sandhu H, et al. Outcomes of open repair for chronic descending thoracic aortic dissection. Ann Thorac Surg. 2015;99:786–93.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Konstadinos A. Plestis
    • 1
    • 2
    • 3
    Email author
  • Oleg I. Orlov
    • 1
    • 4
  • Vishal N. Shah
    • 1
    • 4
  • Robert J. Meisner
    • 5
  • Cinthia P. Orlov
    • 1
    • 4
  • Serge Sicouri
    • 4
    Email author
  1. 1.Division of Cardiothoracic SurgeryLankenau Heart InstituteWynnewoodUSA
  2. 2.Division of Cardiothoracic and Vascular Surgery, Lankenau Heart InstituteMain Line HealthWynnewoodUSA
  3. 3.Clinical and Educational Scholarship Track, Sidney Kimmel Medical College, Lankenau Heart InstituteThomas Jefferson UniversityWynnewoodUSA
  4. 4.Lankenau Institute for Medical ResearchWynnewoodUSA
  5. 5.Division of Vascular SurgeryLankenau Medical CenterWynnewoodUSA

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