Quality of patients life after surgical treatment of dissecting aortic aneurysm type B and aneurysms of descending aorta

Quality of life at the patients with dissecting aortic aneurysm type B and aneurysms of descending aorta were studied with SF-36 questionnaire before and after surgical treatment. Quality of patients life before and after surgical treatment is lower compared with health population. Reconstructive operation takes beneficial effect on life quality at long-term postoperative period.     

Current status of medical therapy of acute dissecting aneurysms of the aorta

In 6 series of patients with acute dissecting aneurysms of the aorta reported during 1970–1979, the best results were obtained by intensive drug therapy initially to correct hypertension and stabilize the patient, then diagnosis by aortography, and then surgical repair for Type A aneurysms involving the ascending aorta, and drug therapy alone for Type B aneurysms involving the descending thoracic aorta. Using this plan of treatment, mortality rates were 30% in patients with Type A dissections (surgical therapy) and 20% in those with Type B dissections (drug therapy).

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Résumé Dans 6 séries d'anévrismes disséquants aigus de l'aorte publiées entre 1970 et 1979, les meilleurs résultats ont été obtenus par: (1) traitement d'abord médical, intensif, pour corriger l'hypertension et stabiliser l'état du malade, suivi d'une aortographie de diagnostic et d'une correction chirurgicale, dans les anévrismes de type A qui intéressent l'aorte ascendante, (2) traitement uniquement médical dans les anévrismes de type B localisés à l'aorte descendante. Avec ce schéma de traitement, la mortalité a été de 30% dans les dissections de type A (traitement chirurgical) et de 20% dans les cas de type B (traitement médical).

     

Renovascular hypertension following surgical repair of dissecting aneurysm of the thoracic aorta

A critically ill patient with refractory renovascular hypertension following successful intrathoracic repair of a type I aortic dissection was treated successfully with gelfoam embolization of the left kidney. Renal artery stenosis secondary to aortic dissection can exacerbate pre-existent hypertension in the preoperative or postoperative periods and can be diagnosed angiographically. Unilateral renal artery embolization may provide a safe alternative to nephrectomy for renovascular hypertension in cases where surgery is not feasible.     

Chronic dissecting aorta aneurysm: a medical or surgical disease?

The surgical results obtained in 40 cases of chronic dissecting aorta aneurysm are reported and compared with the results obtained in medically treated cases. Improved results with improved surgical techniques are described and the superiority of surgical treatment as opposed to medical treatment is stressed. Although mortality is decreasing, it is still very high and many surgical problems remain unsolved.     

Recent advancement of surgical treatment of aneurysms of the thoracic aorta]

The recent advancement of surgical treatment for aneurysms of the thoracic aorta with special reference to the operative technique and adjunctive methods of distal aortic perfusion during aortic cross-clamping were reviewed. Between 1960 and July, 1991, 415 patients underwent operation for aneurysms of the thoracic aorta in our institution. The overall early mortality rates were 7.7% for the nonruptured aneurysms and 30.6% for the ruptured aneurysms during the last 10 years with recent establishment of mechanical adjuncts and refinement of operative technique. Composite graft replacement with coronary reimplantation was employed in the treatment of annuloaortic ectasia. Selective cerebral perfusion (SCP) with an open aortic anastomosis is a useful adjunct in the treatment for aneurysms of the aortic arch. Graft inclusion technique (Crawford's method) with the aid of a partial bypass is a valid technique for the treatment of thoracoabdominal aortic aneurysms involving visceral branches. Emergency operation is necessary for acute type A aortic dissection to prevent the sudden death due to cardiac tamponade. Acute aortic arch dissection can be treated surgically by replacing both the ascending aorta and aortic arch with prosthetic graft using SCP and open aortic anastomosis. Because of poor prognosis of the aneurysms of the thoracic aorta, and improvement in present surgical results, it now seems justifiable to support an aggressive surgical approach to this disease, before the fatal rupture occurred.     

Traumatic aneurysms of the thoracic aorta

Under observation were 12 patients with traumatic aneurysms of the descending thoracic aorta, 11 of them were operated on. Diagnostic thoracotomy had been performed in the past in 4 patients. In 50% of the patients the course of the disease was asymptomatic. Resection of the aneurysm with alloplastic prosthesis under conditions of superficial hypothermia was performed in all of the patients. The average time of compression of the aorta for the period of reconstruction of the aneurysm was 40.1 min. One lethal outcome took place. There were no paraplegia, no complications of the operative and postoperative period.     

Penetrating ulcers of the descending thoracic aorta: Diagnosis and surgical management

In this paper two patients with penetrating ulcers of the descending thoracic aorta are presented, a clinical condition recognized only recently, that may have a severe or even fatal outcome, due to rupture of the aorta. It is a peculiar form of the atherosclerotic disease, and its clinical and imagiologic presentation may mimics the classic aortic dissection of the distal type type. Computed tomography, nuclear magnetic resonance and transesophageal ecocardiography are the most apropriate methods for studying and diagnosis and the surgical management, aimed at the prevention or treatment of the aortic rupture, and based on the prosthetic aortic replacement, is the only alternative allowing the definite cure of the disease. The main features of pathology, clinical manifestations, diferential diagnosis and surgical management of this entity are described and discussed, according to the most recently articles published in the literature, on the subject.     

Postoperative aneurysms of the thoracic aorta

An examination of 15 patients with postoperative aneurysms of the thoracic aorta was performed. The aneurysms were formed approximately within 15.6 years after operations on the thoracic aorta: for coarctation of the aorta--9 patients, aorta aneurysms--3 patients, open arterial ducts--1 patients, stenosing aortitis--2 patients. Operations were made on 13 patients, 2 patients were not operated upon. In 12 patients moderate hypothermia was used, one patient was operated under conditions of normothermia. The average time of the aorta compression was 42.7 min. Prostheses were used in 9 patients, lateral plasty with a synthetic flap--in 3 patients. Direct anastomosis of the aorta ends after aneurysm resection was used in 1 patient. There were no cases of paraplegia or lethal outcomes. Good results were obtained in all the patients.     

Traumatic aneurysms of the descending thoracic aorta

From July 1979 to December 1985 we observed 51 patients with traumatic lesions of the descending thoracic aorta. Twenty-nine had acute ruptures, mostly accompanied by multiple injuries, and 27 had to be operated upon immediately. Twenty-two patients (19 males, 3 females) had chronic traumatic aneurysms of the descending thoracic aorta (more than six weeks after trauma). Mean age at the time of trauma was 24 years. Mean age at time of surgery was 36.5 years. Twelve patients were symptomatic. All were treated surgically. At surgery, complete aortic disruption was found in 15 patients and partial rupture in seven. We did not use aortic shunting of any kind, only aortic cross-clamping. Hypertension was controlled by intravenous drug infusion. The ruptured aortic segment was replaced in all cases by prosthetic Dacron graft. There were no operative deaths. One patient (age 77) died 11 weeks after surgery from multiple organ failure. One case of postoperative paraplegia was observed. This patient recovered almost completely from his neurological deficit.     

Post-traumatic aneurysms of the thoracic aorta.

Nineteen patients with histologically proved post-traumatic aneurysm of the thoracic aorta were reviewed. Only seven aneurysms were detected at the time of hospitalization for trauma. Eight of 12 patients with chronic aneurysms either became symptomatic or showed enlargment during a period of observation. Surgical excision was the recommended method of therapy.