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Rusults of Classical Crawford and Hybrid Operations in Thoracic-Abdominal Aorta Aneursysms Treatment - Comperative Assesment

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Janczak D., Skóra J., Garcarek J., Merenda M., Litarski A.

Polish Journal of Surgery

2012

vol. 84

issue 3

126-135

Thoracic-abdominal aortic aneurysms (TAAA) are still serious medical problem. Classical procedure requires two cavities approach and implantation of vascular prosthetic in the place of aneurysm - Crawford's procedure. Significant progress was made during last years by using endovascular procedures (stentgrafts). Alternative is hybrid procedure - prosthetic appliance of visceral and kidney arteries and then stentgraft implantation in whole thoracic-abdominal aorta.The aim of the study was comparative analysis of classical and hybrid procedures in thoracic-abdominal aneurysms treatment.Material and methods. Between 1989-2011 in Department of Vascular, General and Transplantological Surgery Medical University in Wrocław and Surgical Department of 4th Military Clinical Hospital in Wrocław 53 patients were operated due to thoracic-abdominal aortic aneurysms. Classical Crawford's procedure was performed in 41 patients (group I) and hybrid procedure was performed in 12 patients (group II). Additionally 7 patients required aortic arc branches reconstruction due to achieve optimal conditions to stentgraft amplantation. Procedures were performed at one or two stages.Results. Mortality in patients treated classically (group I) depended on type of aneurysm in Crawford's classification. In type I-II mortality rate was 54% ((7 deaths/12 patients), in type III do V 17% (5 deaths/ 29 patients). In the group after hybrid procedure (group II) mortality rate was 28% (2 deaths/ 7 patients) in type I-II and 20% (1 death/5 patients) in type III to V. Observed serious perioperative complications.Conclusions. 1. Endovascular procedures development enabled introducing of new methods in thoracic-abdominal aortic aneurysms treatment (hybrid procedures) and allowed to get better results. 2. Clear advantage of hybrid procedures above classical Crawford's procedure is observed in type I and II of TAAA. 3. Mortality and morbidity rates recommend hybrid procedure in type I and II of TAAA. 4. Surgical results of classical and hybrid procedures in type III-V TAAA treatment are comparative, with indication on classical approach.

Own Clinical Observations of Treatment Outcome in Acute Type B Aortic Dissection

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Janczak D., Skóra J., Garcarek J., Litarski A., Merenda M., Wieraszko A.

The aim of the study was to analyse early results of treatment of acute type B aortic dissection.Material and methods. 59 patients, treated between 1998 and 2011, were divided into four groups. Group I comprised ten patients in whom hybrid procedures were performed: extra-anatomical by-pass graft from the brachio-cephalic trunk to the left carotid artery in six patients, transposition of the left carotid artery to the right one in two patients, and reversed Y prosthesis from the brachio-cephalic trunk to both carotids in the remaining 2 patients, to facilitate stent-grafting. Group II comprised 13 patientsin whom endovascular procedures were performed (stent-grafting). Group III comprised 21 patients in whom conventional surgery was done. Group IV comprised 15 patients who were treated conservatively.Results. In group I, a very good clinical outcome, without complications, was achieved in six patients (60% of cases). The total mortality rate was 40%. One patient died on the operation table, following stent-grafting, due to the rupture of the aortic arch. Two patients died as a result of brain damage (cerebral aneurysm rupture in one, and ischemic stroke in the other). In one patient, an aorto-oesophageal fistula developed. In group II, one patient died during endovascular procedure. Another patient suffered from type 1 endoleak, requiring repeated endovascular surgery. In group III, 15 patients (72%) died. Moreover, four patients required acorrective cardiac surgery (Bentall procedure)which in three patients resulted in death. Thus, the total mortality rate in this group was as high as 85%. In group IV, the mortality rate was 13%.Conclusions. We noticed a clear superiority of endovascular procedures over conventional surgeries-for acute type B aortic dissection. Hybrid procedures for acute, complicated type B aortic dissection evidently reduce mortality and postoperative morbidity. Uncomplicated acute type B aortic dissections should be treated conservatively at intensivecare units.

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2 Polish Journal of Surgery

2 2012

2 Garcarek J.

2 Janczak D.

2 Litarski A.

2 Merenda M.

2 Skóra J.

1 Wieraszko A.

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Rusults of Classical Crawford and Hybrid Operations in Thoracic-Abdominal Aorta Aneursysms Treatment - Comperative Assesment

Own Clinical Observations of Treatment Outcome in Acute Type B Aortic Dissection