Progress in treatment of thoracoabdominal and abdominal aortic aneurysms involving celiac, superior mesenteric, and renal arteries.

This is a report of surgical treatment of thoracoabdominal aortic aneurysms and aneurysms of the abdominal aorta from which the visceral vessels arise during the 18 year period from April 5, 1960, to April 20, 1978. The extent of aneurysm is divided into five groups. Group I (10 patients) involved most of the thoracic and abdominal aorta down to celiac axis. Group II (22 patients) involved most of the thoracic and abdominal aorta distal to left subclavian artery. Group III (20 patients) were those with lesser involvement of the thoracic aorta and most of the abdominal aorta. Group IV (18 patients) with involvement of the entire abdominal aorta and Group V (12 patients) with involvement of lower abdominal aorta and renal arteries. Treatment in the majority of these cases was by graft inclusion technique with visceral vessel reattachment by direct suture of orifice to openings made in the graft. Intercostal and/or lumbar arteries were also reattached in some with the more extensive lesions. Aortic and renal artery occlusion times varied from 15 to 155 minutes. Paraplegia developed in five patients with the more extensive lesions but was reduced to one-third and made less severe by reattaching intercostal and lumbar arteries. Renal dysfunction was mild in four patients and severe in three patients after operation. All these were transient except one who died while recovering from renal failure. The latter cases were those difficult to reattach or were not initially successful and required reoperation. Of the 82 patients, 77 (94%) survived operation and long-term followup was obtained in 95% of cases, 23 performed over five years ago. Actuarial curves were constructed and compared to survival curves following simple infrarenal abdominal aortic resection. The survival rate both immediately and at six years, were the same.