Late complications after surgical exclusion of the thoracic aorta

Abstract

Two patients who underwent surgical exclusion of the thoracic aorta for chronic dissecting aneurysms of the descending aorta died 4 and 8 years after surgery due to complications in part related to the operative technique. One patient developed pseudoaneurysm of the proximal aortic stump with fatal exsanguination through an aortapulmonary fistula. The other patient developed progressive dilatation of the remaining abdominal aorta with subsequent rupture. The surgical approach in this case was extremely difficult because of the previous exclusion procedure which determined a highly demanding reoperation. Although surgical exclusion of the thoracic aortic may be a useful technique in some situations, we must be aware of its early and late complications and, in our opinion, it should be seen only as an alternative treatment for very special patients with diseases of the descending thoracic aorta.

A case of a highly tortuous descending thoracic aortic aneurysm treated by surgical exclusion

“…Aneurysmal exclusion removes the stress of the systemic arterial pressure from the aneurysm and results in complete intra-aneurysmal thrombosis, which prevents rupture. [1][2][3][4] However, complete thrombosis does not always develop in the aneurysm after total exclusion, because of anticoagulant therapy or patent branching arteries. Therefore, the excluded aneurysm could sometimes develop progressive dilatation or rupture, which requires re-operation, during long-term follow-up period after the surgery.…”

“…Therefore, the excluded aneurysm could sometimes develop progressive dilatation or rupture, which requires re-operation, during long-term follow-up period after the surgery. [3][4][5][6] Resnikoff et al 5 reported that 2% of patients who underwent abdominal aortic aneurysmal exclusion were found to have a patent aneurysmal sac, and most of them required surgical intervention. In the present patient, it was anticipated that the control of blood flow from the intercostal arteries originating from the aneurysm would be difficult because the main body of the aneurysm was not directly visible through the surgical field.…”