TREATMENT OF CHRONIC EXPANDING DISSECTING ANEURYSMS OF THE DESCENDINGTHORACIC AND UPPER ABDOMINAL-AORTA BY EXTENDED AORTOTOMY, REMOVAL OF THE DISSECTED INTIMA, AND CLOSURE

Purpose: The incidence of complications, particularly paraplegia, rema ins high after surgical repair of DeBakey type IIIB chronic expanding dissecting aneurysms. In this report we cautiously advocate a new appr oach termed tailored aortoplasty, which allows the surgeon to achieve two primary goals: reduced renal/visceral and spinal cord ischemic tim e, and reperfusion of all patent inferior intercostal and superior lum bar arteries. Methods: Tailored aortoplasty consists of incising the c ontrolled aorta on the left posterolateral surface from T-8 to the inf rarenal portion. The membrane separating the true and false lumen is e xcised, and the aortotomy is closed to a diameter of 2 1/2 to 3 cm to reduce wall tension. Results: The procedure has been applied to 13 pat ients, all of whom survived, nine without complications. One patient h ad paresis after profound cardiogenic shock. Three patients had hemorr hage, one from an excluded intercostal artery, one from a delayed sple nic rupture, and one from the suture line. He was the only patient tre ated for acute dissection with rupture. Conclusions: Confining the pro cedure to chronic dissections, we found aortic tissues capable of hold ing sutures well, and there has been no expansion of the tailored segm ent on computed tomography or magnetic resonance imaging in mean follo w-up of 2.1 years.