Abstract： Objective To study the spinal cord protection effect of cerebrospinal fluid drainage （CSFD）for patients undergoing thoracoabdominal aortic aneurysm surgery. Methods We randomly allocated 30 patients undergoing thoracoabdominal aortic aneurysm surgery in Beijing Anzhen Hospital from December 2008 to August 2009 into a CSFD group with 15 patients（12 males, 3 females; average age of 45.0 years） and a control group with 15 patients（11 males, 4 females; average age at 45.8 years）by computer. All the patients underwent replacement of ascending aorta and aortic arch, implantation of descending aorta stent, or thoracoabdominal aorta replacement. Some patients underwent Bentall operation or replacement of half aortic arch. Patients in the CSFD group also underwent CSFD. Serum S100B, glial fibrillary acidic protein and neuron-specific enolase were measured at set intraoperative and postoperative times. All the patients were scored preoperatively, 72 hours postoperatively, and before discharge according to the National Institutes of Health Stroke Scale and International Standards for Neurological Classification of Spinal Cord Injury. Results Central nervous system injury occurred in four patients in the control group： one died of both brain damage and spinal cord damage; one patient had spinal cord injury and became better after treatment by early CSFD; two patients had brain damage（one patient died, another patient had concomitant acute renal failure and acute respiratory failure, recovered and was discharged after treatment）. In the CSFD group, only one patient died of acute respiratory failure and subsequent multiple organ system failure, and all other patients recovered very well. There was no late death during three months follow-up in both groups. The average serum S100B, glial fibrillary acidic protein，and neuron-specific enolase concentrations of the CSFD group patients were significantly lower than those of the control group （F=7.153，P=0.012；F=3.263，P=0.082；F=4.927，P=0.035）. Conclusion Selected CSFD is a safe, effective and feasible procedure to protect the spinal cord from ischemic damage during the perioperative period of thoracoabdominal aortic aneurysm surgery.
Objective To investigate the further results of thoracoabdominal aortic aneurysm (TAAA) repair， and analyze the midterm results of 63 cases treated by total thoraco abdominal aortic replacement with a tetrafurcate graft. Methods From August 2003 to October 2007，total thoracoabdominal aortic replacement with a tetrafurcate graft was performed in 63 consecutive patients with Crawford Ⅱ TAAA in Fu Wai Hospital. There were 46 male and 17 female with a mean age of 39.98 years (17-71 years). All the procedures were performed through combined thoracoabdominal incision via the retroperitoneal approach and underwent profound hypothermia with shorttime interval circulatory arrest. T6 to T12 intercostal arteries were reconstructed by arterial tube technique. The celiac artery， superior mesenteric artery and right renal artery were joined into a patch and anastomosed to the end of the main graft. Left renal artery was anastomosed to an 8 mm branch or joined to the visceral arterial patch. The other 10 mm branches were anastomosed to iliac arteries. KaplanMeier method was used to perform survival analysis. Results All the cases were followed，and the mean followup time was 36.57(8-57) months. No patient died during the operation. Early mortality rate was 7.94%（5/63）. Among them， 4 patients died of multiple organ failure. Two of them were caused by neurological complications, and the other 2 of them were caused by renal failure. One patient died of low cardiac output syndrome after surgery because of coronary artery disease. This patient underwent coronary artery bypass grafting (CABG) emergently, but couldn’t wean from cardiopulmonary bypass. The incidence of stroke and temporary neurological dysfunction was 9.52%（6/63）, 4 of them were temporary neurological dysfunction and were cured before discharged from hospital. Paraplegia and paraparesis occurred in 2 and 1, respectively. They were all [CM(158.3mm]cured before leaving hospital. Pulmonary complication was 25.40%(16/63)， and12 of them were cured. Pseudoaneurysmal change was observed in reconstructed intercostal arteries in 2 patients with Marfan syndrome, but neither of them underwent paraplegia or paraparesis. One patient died at 20th, 23rd, 30th month after discharge, respectively. The survival time of this group was 50.64±2.13 months（95%CI：46.47,54.84 months） with a survival rate of 92.06% after 1 year， 88.38% after 2 years， 86.11% after 3 years. Conclusion Using tetrafurcate graft is a reliable method in total thoracoabdominal aortic replacement and has a satisfactory midterm survival rate. The intercostal arteries reconstruction by arterial tube technique in total thoracoabdominal replacement is simple, and it is helpful in spinal cord protection.
目的总结采用分期全主动脉置换治疗急性A型主动脉夹层合并胸腹主动脉瘤的手术方式和早期治疗效果。 方法自2013年2月至2014年2月，2例急性A型主动脉夹层合并Crawford Ⅱ型胸腹主动脉瘤的马方综合征患者进行了分期全主动脉置换手术。患者均为男性，年龄分别为41岁和26岁。一期在部分深低温停循环下行主动脉根部、全弓置换及支架象鼻植入术，二期在常温非体外循环下应用四分叉人工血管行全胸腹主动脉置换术。 结果手术结果满意，2例患者均康复出院，无任何并发症。 结论分期全主动脉置换术治疗急性A型主动脉夹层合并全胸腹主动脉瘤是一种安全、有效的方法。
ObjectiveReporting a case of hybrid procedure of extensive thoracoabdominal aortic aneurysm (TAAA) with type B dissection due to Marfan syndrome (MFS) using a prosthetic graft as the distal landing zone for stent-graft.MethodsRetrospectively summarize in-hospital profiles of a patient for who was diagnosed as MFS complicated with TAAA and type B dissection and admmited to Vascular Surgery Department of West China Hospital in May 2018. A GORE-TEX 18 mm×9 mm Y-shaped graft was sewn side-to-end to the bifurcation of left common iliac artery as the inflow site, and a self-made penta-limb graft was sewn side-to-end to the bifurcation of the 18 mm graft. The visceral and bilateral iliac arteries were reconstructed subsequently. Then, the release of the stent-graft was designed from distal to proximal. The distal part of the stent-graft was anchored into the main body of the 18 mm Y-shaped graft.ResultsThe patient underwent the operation successfully with a duaration of 6 h, blood loss of about 800 mL. No serious postoperative complications occurred. Computed tomography angiography at 2-year follow-up showed that the bypass grafts were patent without endoleak, stent migration, stent infolding or infections of the vessel graft and endograft.ConclusionThis modified management of the landing zone could be a proper choice for this kind of rare case as extensive aneurysm or dissection involved in patients with MFS.
The surgical treatment of thoraco-abdominal aortic aneurysm is a unique solution completed by multidisciplinary cooperation. Preoperative detailed examination and evaluation should be carried out to determine the appropriate point for surgery and optimize the organ function through necessary means. During perioperative period, excellent surgical skills and appropriate strategy of extracorporeal circulation will be adopted according to the scope of involvement, and necessary measures will be utilized to monitor and protect the functions of vital organs. Close monitoring and management in postoperative stage, early warning of complications and effective treatment are essential ways to improve the prognosis of TAAA surgery. This article reviews the research progress in perioperative management of TAAA surgery.
ObjectiveTo explore the efficacy and safety of hybrid surgery in the treatment of thoracoabdominal aortic aneurysm (TAAA). MethodsTwenty patients who were diagnosed with TAAA (including chronic thoracoabdominal aortic dissection aneurysm) and underwent hybrid surgery in Vascular Surgery, West China Hospital, Sichuan University were enrolled between January 2015 and December 2022. All the patients underwent retrograde reconstruction for visceral arteries in the open surgery. Additionally, one-stage or two-stage endovascular aortic repair with covered stents was performed. The patients’ clinical baseline information was collected. Moreover, the patients received clinical follow-up and imaging examinations postoperatively, whose informationwas collected. ResultsOne patient developed paraplegia and acute renal failure 16 days postoperatively in the hospital, and subsequently died in the hospital due to septic shock. Another patient underwent exploratory laparotomy for hemostasis due to anastomotic bleeding in the hospital. The other patients did not experience serious complications perioperatively. Nineteen patients were discharged from the hospital with long-term follow-up ranging from 10 to 144 months (median time: 48 months), and all of them had a long-term survival. No patients were observed with paraplegia, myocardial infarction, stroke, or rupture of aneurysm. None of the patients received reintervention during the follow-up, except for one patient who underwent ultrasound-guided puncture and suctionin the aneurysmallumen. ConclusionHybrid surgery is an effective treatment for TAAA with favorable short- and long-term safety and efficacy.