Surgical repair of aneurysms involving the suprarenal, visceral, and lowerthoracic aortic segments: Early results and late outcome

Objective: The purpose of this study is to review our experience with surgi cal repair of lower thoracoabdominal and suprarenal aortic aneurysms to det ermine early and late survival rates and identify factors influencing morbi dity and survival among these patients. Materials: From 1989 through 1998, 165 consecutive patients underwent repai r of 108 thoracoabdominal(55 group III and 53 group IV) and 57 suprarenal a neurysms. The study group consisted of 109 men and 56 women with a mean age of 70 years (median, 70 years; range, 29-89 years). Mean aneurysm diameter was 6.9 cm (median, 6.5 cm; range, 4-12 cm), There were 125 aneurysms (76% ) repaired electively; 40 repairs (24%) were nonelective. The cause of 12 a neurysms (7%) was chronic aortic dissection; the remaining 153 (93%) were d egenerative aneurysms. Results: The early postoperative (30-day) mortality rates were 7% (9/125) f or elective and 23% (9/40) for nonelective operations (P = .016). For both elective and urgent procedures, early mortality was 1.8% (1/57) for suprare nal aneurysm repair, 11% (6/53) for group IV thoracoabdominal aneurysms, an d 20% (11/55) for group III thoracoabdominal aneurysms (P = .013, suprarena l vs group III). Spinal cord ischemia occurred after 6% (10/165) of aneurys m repairs (4% paraplegia, 2% paraparesis). None of the 57 suprarenal aneury sm repairs were complicated by spinal cord ischemia, whereas it occurred in 2% (1/53) of group IV thoracoabdominal aneurysms and 16% (9/55) of group I II thoracoabdominal aneurysms (P =.001, suprarenal vs group III; P = .016, group TV vs group III). Three (25%) of the 12 patients with dissection deve loped spinal cord ischemia; this compared with seven (5%) of 153 patients w ith degenerative aneurysms (P = .027). The cumulative a-year survival rate for the entire series was 71% (95% CI, 64%-79%), and 5-year survival was 50 % (95% CI, 40%-60%). Conclusions: Aneurysms involving the suprarenal, visceral, and lower thorac ic aorta may be repaired with acceptable perioperative mortality and late s urvival rates. The risk of spinal cord ischemia is increased for patients w ith aortic dissection and may be stratified according to the proximal exten t of the aneurysm.