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Abdominal and Thoracoabdominal Aortic Replacement for Marfan Syndrome

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Diagnosis and Management of Marfan Syndrome

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Abstract

Thoracoabdominal aortic aneurysm (TAAA) refers to aneurysmal disease affecting variable extents of the thoracic and abdominal aorta concurrently. TAAA may occur as a primary pathology or secondary to aortic dissection. The extent of aortic involvement in TAAA is defined by the Crawford classification (Fig. 10.1), which is the basis for stratifying prognosis and also determines the surgical approach [1].

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References

  1. Crawford ES, 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(3):389–404.

    Article  CAS  PubMed  Google Scholar 

  2. Bickerstaff LK, et al. Thoracic aortic aneurysms: a population-based study. Surgery. 1982;92(6):1103–8.

    CAS  PubMed  Google Scholar 

  3. Hiratzka LF, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. J Am Coll Cardiol. 2010;55(14):1509–44.

    Article  Google Scholar 

  4. Milewicz DM, Dietz HC, Miller DC. Treatment of aortic disease in patients with Marfan syndrome. Circulation. 2005;111(11):e150–7.

    Article  PubMed  Google Scholar 

  5. LeMaire SA, et al. Spectrum of aortic operations in 300 patients with confirmed or suspected Marfan syndrome. Ann Thorac Surg. 2006;81(6):2063–78; discussion 2078.

    Article  PubMed  Google Scholar 

  6. Crawford ES, Cohen ES. Aortic aneurysm: a multifocal disease. Presidential address. Arch Surg (Chicago, Ill.: 1960). 1982;117(11):1393–400.

    Google Scholar 

  7. Finkbohner R, et al. Marfan syndrome. Long-term survival and complications after aortic aneurysm repair. Circulation. 1995;91(3):728–33.

    Article  CAS  PubMed  Google Scholar 

  8. Mommertz G, et al. Thoracoabdominal aortic aneurysm repair in patients with Marfan syndrome. Eur J Vasc Endovasc Surg. 2008;35(2):181–6.

    Article  CAS  PubMed  Google Scholar 

  9. Girdauskas E, et al. Distal aortic reinterventions after root surgery in Marfan patients. Ann Thorac Surg. 2008;86(6):1815–9.

    Article  PubMed  Google Scholar 

  10. Safi HJ, et al. Distal aortic perfusion and cerebrospinal fluid drainage for thoracoabdominal and descending thoracic aortic repair: ten years of organ protection. Ann Surg. 2003;238(3):372–80; discussion 380–1.

    PubMed  PubMed Central  Google Scholar 

  11. Dardik A, et al. Durability of thoracoabdominal aortic aneurysm repair in patients with connective tissue disorders. J Vasc Surg. 2002;36(4):696–703.

    Article  PubMed  Google Scholar 

  12. Kalkat MS, et al. Presentation and outcome of Marfan's syndrome patients with dissection and thoraco-abdominal aortic aneurysm. Eur J Cardiothorac Surg. 2007;32(2):250–4.

    Article  PubMed  Google Scholar 

  13. Gott VL, et al. Replacement of the aortic root in patients with Marfan's syndrome. N Engl J Med. 1999;340(17):1307–13.

    Article  CAS  PubMed  Google Scholar 

  14. Kawamoto S, et al. Thoracoabdominal aorta in Marfan syndrome: MR imaging findings of progression of vasculopathy after surgical repair. Radiology. 1997;203(3):727–32.

    Article  CAS  PubMed  Google Scholar 

  15. Omura A, et al. Early and late results of graft replacement for dissecting aneurysm of thoracoabdominal aorta in patients with Marfan syndrome. Ann Thorac Surg. 2012;94(3):759–65.

    Article  PubMed  Google Scholar 

  16. Albornoz G, et al. Familial thoracic aortic aneurysms and dissections--incidence, modes of inheritance, and phenotypic patterns. Ann Thorac Surg. 2006;82(4):1400–5.

    Article  PubMed  Google Scholar 

  17. Weerakkody R, et al. Genetic analysis of aneurysm and dissection of the descending thoracic aorta using next-generation sequencing. Br J Surg. 2014;101:8–9, 2p. Suppl.: 2 Special Issue: SI.

    Google Scholar 

  18. Elefteriades JA. Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. Ann Thorac Surg. 2002;74(5):S1877–80; discussion S1892–8.

    Article  PubMed  Google Scholar 

  19. Umana JP, Miller DC, Mitchell RS. What is the best treatment for patients with acute type B aortic dissections--medical, surgical, or endovascular stent-grafting? Ann Thorac Surg. 2002;74(5):S1840–3; discussion S1857–63.

    Article  PubMed  Google Scholar 

  20. Safi HJ, et al. Effect of extended cross-clamp time during thoracoabdominal aortic aneurysm repair. Ann Thorac Surg. 1998;66(4):1204–9.

    Article  CAS  PubMed  Google Scholar 

  21. MacArthur RG, et al. Organ protection during thoracoabdominal aortic surgery: rationale for a multimodality approach. Semin Cardiothorac Vasc Anesth. 2005;9(2):143–9.

    Article  PubMed  Google Scholar 

  22. Safi HJ, et al. Progress and future challenges in thoracoabdominal aortic aneurysm management. World J Surg. 2008;32(3):355–60.

    Article  PubMed  Google Scholar 

  23. Hollier LH, et al. Risk of spinal cord dysfunction in patients undergoing thoracoabdominal aortic replacement. Am J Surg. 1992;164(3):210–3; discussion 213–4.

    Article  CAS  PubMed  Google Scholar 

  24. Acher CW, et al. Combined use of cerebral spinal fluid drainage and naloxone reduces the risk of paraplegia in thoracoabdominal aneurysm repair. J Vasc Surg. 1994;19(2):236–46; discussion 247–8.

    Article  CAS  PubMed  Google Scholar 

  25. Safi HJ, et al. Cerebrospinal fluid drainage and distal aortic perfusion: reducing neurologic complications in repair of thoracoabdominal aortic aneurysm types I and II. J Vasc Surg. 1996;23(2):223–8; discussion 229.

    Article  CAS  PubMed  Google Scholar 

  26. Svensson LG, et al. Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg. 1993;17(2):357–68; discussion 368–70.

    Article  CAS  PubMed  Google Scholar 

  27. Zoli S, et al. Predicting the risk of paraplegia after thoracic and thoracoabdominal aneurysm repair. Ann Thorac Surg. 2010;90(4):1237–44; discussion 1245.

    Article  PubMed  Google Scholar 

  28. Shiiya N, et al. Spinal cord protection during thoracoabdominal aortic aneurysm repair: results of selective reconstruction of the critical segmental arteries guided by evoked spinal cord potential monitoring. J Vasc Surg. 1995;21(6):970–5.

    Article  CAS  PubMed  Google Scholar 

  29. Safi HJ, et al. Importance of intercostal artery reattachment during thoracoabdominal aortic aneurysm repair. J Vasc Surg. 1998;27(1):58–66; discussion 66–8.

    Article  CAS  PubMed  Google Scholar 

  30. Ross SD, et al. Preservation of intercostal arteries during thoracoabdominal aortic aneurysm surgery: a retrospective study. J Thorac Cardiovasc Surg. 1999;118(1):17–25.

    Article  CAS  PubMed  Google Scholar 

  31. Jacobs MJ, et al. The value of motor evoked potentials in reducing paraplegia during thoracoabdominal aneurysm repair. J Vasc Surg. 2006;43(2):239–46.

    Article  PubMed  Google Scholar 

  32. Webb TH, Williams GM. Thoracoabdominal aneurysm repair. Cardiovasc Surg. 1999;7(6):573–85.

    Article  CAS  PubMed  Google Scholar 

  33. Williams GM, et al. Preoperative selective intercostal angiography in patients undergoing thoracoabdominal aneurysm repair. J Vasc Surg. 2004;39(2):314–21.

    Article  PubMed  Google Scholar 

  34. Black JH, Davison JK, Cambria RP. Regional hypothermia with epidural cooling for prevention of spinal cord ischemic complications after thoracoabdominal aortic surgery. Semin Thorac Cardiovasc Surg. 2003;15(4):345–52.

    Article  PubMed  Google Scholar 

  35. Wisselink W, et al. Ischemia-reperfusion injury of the spinal cord: protective effect of the hydroxyl radical scavenger dimethylthiourea. J Vasc Surg. 1994;20(3):444–91; discussion 449–50.

    Article  CAS  PubMed  Google Scholar 

  36. Donas KP, et al. Early and midterm outcome of a novel technique to simplify the hybrid procedures in the treatment of thoracoabdominal and pararenal aortic aneurysms. J Vasc Surg. 2009;50(6):1280–4.

    Article  PubMed  Google Scholar 

  37. Watanabe Y, et al. Successful endografting with simultaneous visceral artery bypass grafting for severely calcified thoracoabdominal aortic aneurysm. J Vasc Surg. 2002;35(2):397–9.

    Article  PubMed  Google Scholar 

  38. Kotsis T, et al. Treatment of thoracoabdominal aortic aneurysms with a combined endovascular and surgical approach. Int Angiol. 2003;22(2):125–33.

    CAS  PubMed  Google Scholar 

  39. Svensson LG, et al. Elephant trunk procedure: newer indications and uses. Ann Thorac Surg. 2004;78(1):109–16; discussion 109–16.

    Article  PubMed  Google Scholar 

  40. Flye MW, et al. Retrograde visceral vessel revascularization followed by endovascular aneurysm exclusion as an alternative to open surgical repair of thoracoabdominal aortic aneurysm. J Vasc Surg. 2004;39(2):454–8.

    Article  PubMed  Google Scholar 

  41. Fulton JJ, et al. Endovascular stent-graft repair of pararenal and type IV thoracoabdominal aortic aneurysms with adjunctive visceral reconstruction. J Vasc Surg. 2005;41(2):191–8.

    Article  PubMed  Google Scholar 

  42. Bianchini Massoni C, et al. Follow-up outcomes of hybrid procedures for thoracoabdominal aortic pathologies with special focus on graft patency and late mortality. J Vasc Surg. 2014;59(5):1265–73.

    Article  PubMed  Google Scholar 

  43. Riambau V, et al. Final operative and midterm results of the European experience in the RELAY Endovascular Registry for Thoracic Disease (RESTORE) study. J Vasc Surg. 2011;53(3):565–73.

    Article  PubMed  Google Scholar 

  44. Nienaber CA, et al. Strategies for subacute/chronic type B aortic dissection: the Investigation of Stent Grafts in Patients with type B Aortic Dissection (INSTEAD) trial 1-year outcome. J Thorac Cardiovasc Surg. 2010;140(6 Suppl):S101–8; discussion S142–46.

    Article  PubMed  Google Scholar 

  45. Cooper DG, et al. Treating the thoracic aorta in Marfan syndrome: surgery or TEVAR? J Endovasc Ther. 2009;16(1):60–70.

    Article  PubMed  Google Scholar 

  46. Pacini D, et al. Endovascular treatment for type B dissection in Marfan syndrome: is it worthwhile? Ann Thorac Surg. 2013;95(2):737–49.

    Article  PubMed  Google Scholar 

  47. Metafratzi ZM, et al. The clinical significance of aortic compliance and its assessment with magnetic resonance imaging. J Cardiovasc Magn Reson. 2003;4(4):481–91.

    Article  Google Scholar 

  48. Dingemans KP, et al. Ultrastructural pathology of aortic dissections in patients with Marfan syndrome: comparison with dissections in patients without Marfan syndrome. Cardiovasc Pathol. 2006;15(4):203–12.

    Article  PubMed  Google Scholar 

  49. Pereira L, et al. Pathogenetic sequence for aneurysm revealed in mice underexpressing fibrillin-1. Proc Natl Acad Sci U S A. 1999;96(7):3819–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Resch TA, et al. Combined staged procedures for the treatment of thoracoabdominal aneurysms. J Endovasc Ther. 2006;13(4):481–9.

    Article  PubMed  Google Scholar 

  51. Karthikesalingam A, et al. Volume-outcome relationships in vascular surgery: the current status. J Endovasc Ther. 2010;17(3):356–65.

    Article  PubMed  Google Scholar 

  52. Coselli JS, et al. Morbidity and mortality after extent II thoracoabdominal aortic aneurysm repair. Ann Thorac Surg. 2002;73(4):1107–15; discussion 1115–6.

    Article  PubMed  Google Scholar 

  53. Coselli J, Bozinovski J, LeMaire SA. Open surgical repair of 2286 thoracoabdominal aortic aneurysms. Ann Thorac Surg. 2007;83:S862–4.

    Article  PubMed  Google Scholar 

  54. Thrumurthy SG, et al. A systematic review of mid-term outcomes of thoracic endovascular repair (TEVAR) of chronic type B aortic dissection. Eur J Vasc Endovasc Surg. 2011;42(5):632–47.

    Article  CAS  PubMed  Google Scholar 

  55. Kische S, et al. Endovascular treatment of acute and chronic aortic dissection: midterm results from the Talent Thoracic Retrospective Registry. J Thorac Cardiovasc Surg. 2009;138(1):115–24.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Imperial College London, London, UK

    Ruwan A. Weerakkody PhD & Nicholas J. Cheshire MD, FRCS(Eng), FRCS(Ed)

  2. Department of Surgery, Royal Brompton and Harefield Aortic Centre, London, UK

    Ulrich Rosendahl & Nicholas J. Cheshire MD, FRCS(Eng), FRCS(Ed)

  3. Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Heart and Vascular Institute, University of Texas, Austin, TX, USA

    Anthony L. Estrera & Hazim J. Safi

Authors
  1. Ruwan A. Weerakkody PhD
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  2. Ulrich Rosendahl
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  3. Anthony L. Estrera
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  4. Hazim J. Safi
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  5. Nicholas J. Cheshire MD, FRCS(Eng), FRCS(Ed)
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Correspondence to Ruwan A. Weerakkody PhD .

Editor information

Editors and Affiliations

  1. Cardiovascular & Cell Sciences Research, St George's, University of London, London, United Kingdom

    Anne H. Child

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Weerakkody, R.A., Rosendahl, U., Estrera, A.L., Safi, H.J., Cheshire, N.J. (2016). Abdominal and Thoracoabdominal Aortic Replacement for Marfan Syndrome. In: Child, A. (eds) Diagnosis and Management of Marfan Syndrome. Springer, London. https://doi.org/10.1007/978-1-4471-5442-6_10

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  • DOI: https://doi.org/10.1007/978-1-4471-5442-6_10

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