SURGICAL-TREATMENT OF THORACOABDOMINAL AORTIC-ANEURYSMS BY SIMPLE CROSS-CLAMPING - RISK-FACTORS AND LATE RESULTS

Between 1981 and 1987, 88 consecutive patients were operated on for a thoracoabdominal aortic aneurysm by simple crossclamping and a graft i nclusion technique (without shunts or heparin). This article presents an analysis of the operative outcome and long-term follow-up. Patient- and operation-related variables are age (mean 64.3 years, range 28 to 82 years), sex (82% men), rupture (20.5%), diabetes (2.3%), renal ins ufficiency (34.1%), chronic obstructive pulmonary disease (27.3%), pre vious aortic operation (31.8%), arterial hypertension (66%), postdisse ction (18.2%) versus degenerative (80.7%) origin, preoperative shock ( 11.4%), ischemic cerebrovascular (12.5%) or ischemic heart (17%) disea se, peripheral vascular disease (14.8%), renal (mean 48 minutes, range 0 to 83 minutes) and lower spinal cord (mean 21 minutes, range 0 to 6 8 minutes) ischemic time, number of reattached intercostals, blood los s, and extent of the aneurysm (Crawford classification: type I, 16 pat ients [18.2%]; type II, 21 patients [23.8%]; type III, 29 patients [33 %]; and type IV, 22 patients [25%]. Intraoperative mortality is 1.1% ( n = 1). Thirty-day mortality is 5.9% (n = 5). Hospital mortality is 11 .4% (n = 10): 7% for elective cases and 28% for ruptured aneurysms (p = 0.014). The survival at 2 years is 78% +/- (4.4%) and at 5 years 54% +/- (5.3%). Postoperative spinal cord injury occurred in 12 patients (13.8%) (5 had paraplegia and 7 had paraparesis) and postoperative ren al dysfunction necessitating dialysis in 12 patients (14.1%). Risk str atification for hospital death, late death, renal failure, and spinal cord dysfunction was performed by means of multivariate logistic regre ssion and Cox proportional hazard regression as appropriate. The best fitting model to predict hospital death includes preoperative shock (p = 0.02), female sex (p = 0.06), preoperative elevated serum creatinin e level (p = 0.06), and preoperative myocardial infarction (p = 0.08). Variables predictive for late death are postoperative dialysis (p = 0 .002), age (p = 0.008), and rupture (p = 0.04). The risk factors of po stoperative dialysis are age (p = 0.003) and preoperative serum creati nine level (p = 0.04). The risk of postoperative spinal cord dysfuncti on increases with longer lower spinal cord ischemic time (p = 0.02) an d with the presence of preoperative shock (p = 0.06).