REDUCING MORBIDITY OF THORACOABDOMINAL ANEURYSM REPAIR BY PRELIMINARYAXILLOFEMORAL BYPASS

BACKGROUND: Thoracoabdominal aneurysm (TAA) repair continues to be ass ociated with appreciable morbidity and mortality. To reduce the substa ntial cardiac afterload of thoracic aortic clamping, preserve visceral , renal, and lower-extremity perfusion, and reduce spinal cord ischemi a, a right axillofemoral bypass was performed before TAA resection. PA TIENTS AND METHODS: Fifteen patients undergoing repair of their TAA ha d a preliminary axillofemoral bypass with an 8- to 10-mm externally su pported polytetrafluoroethylene graft. Nine underwent elective repair and 6 were operated on emergently, All but 2 patients (both had type I V aneurysms) had spinal fluid drainage and all had moderate hypothermi a induced (31 degrees C to 32 degrees C). All visible intercostal arte ries were reimplanted. RESULTS: Requirements for pharmacologic afterlo ad reduction were minimal, Urine output was preserved during proximal aortic and intercostal anastomoses, and acidosis was minimal, Anticoag ulation was not necessary unless the aortic bifurcation was replaced, and no patient had thrombotic complications, One (7%) patient died aft er repair of a ruptured aneurysm, and 1 (7%) developed paraplegia and required temporary dialysis. CONCLUSION: Preliminary axillofemoral byp ass avoids the profound hemodynamic and physiologic derangement caused by clamping of the thoracic aorta, and effectively reduces the morbid ity of TAA repair.