Late Results of the Surgical Treatment for Aortic Dissections

Abstract

The results of 32 patients who had undergone surgery for aortic dissections were analyzed. Twenty-six patients were examined in hospital during the follow-up study while one patient refused the examination and 5 others had succumbed. The average follow-up was 42.6 months. Late functional status was generally good. Resuspension of the aortic annulus for incompetent aortic valves in type I and II dissections resulted in grave aortic regurgitation and death in one case, and in mild valvular incompetence in another case, while 5 patients had competent valves after resuspension. Computed tomography (CT) and angiographic studies frequently revealed residual changes such as double lumen of the aorta. Five subsequent aortic aneurysms were discovered, 4 of them having been reoperated after the study was completed. Periodical follow-up and screening of the aorta of operative survivors is recommended.

Thoracic Outlet Syndrome with Subclavian Artery Thrombosis Caused by Synostosis of the First and Second Ribs

“…The reported incidence of TOS in the general population is 0.3% to 0.7% 16 , but some authors have argued that the real incidence is closer to 1% or 2% 17,18 . Although most patients with TOS present with neurologic symptoms, only 5% exhibits vascular symptoms 19-21 .…”

“…Bramwell recognized the first rib as a cause of TOS in 1903 42 , and resection of the first rib for TOS was first performed in 1910 43 . The surgical management of TOS is highly successful; first rib resection yields an 80% success rate 20 . Interestingly, complete resolution of an arterial aneurysm after scalenectomy and excision of the malformed first rib was achieved without reconstruction of the affected vessel 44 .…”

Use of an Intraluminal Double-ring Vascular Prosthesis in Thoracic Aorta Reconstruction

“…This fact is born e out by a recent contro l study documenti ng persisting dissection in about 2 thirds of patient s und ergoing implanta tion of stan dard vascular pro stheses, i.e. sutur e of the proximal and dist al anastom oses ( 10). The su tur eless technique of fixing pro stheses in thoraeie aort ic dissection has offered an alrnost perfect solu tion to the probl em .…”