IDENTIFICATION OF RISK-FACTORS IN PATIENTS UNDERGOING THORACOABDOMINAL ANEURYSM REPAIR

Developments and advances in surgical and anesthetic techniques have l ead to increased survival in patients undergoing complex thoracic aort ic aneurysm repairs. The decision to operate, however, continues to be based in a large degree on the clinical impression of the patient's a bility to withstand the rigors of the procedure. As part of the ongoin g effort of our department to further elucidate those parameters that impart added risk to patients, the diameters and volumes of CT-imaged aortas were determined for 67 surgical and nonoperatively managed pati ents. Significant differences were found between those patients not re quiring surgery, and both those undergoing operation and those that di ed of rupture. Similarly, the average yearly increase in volume in sur gical and rupture patients was higher than that of nonoperatively mana ged patients. Those patients who smoked also were found to have a sign ificant yearly increase in size of their aortas relative to those pate nts that did not. An algorithm for managing patients presenting with t horacoabdominal aneurysms based upon size at initial presentation, cha nge in annual diameter and volume, and estimated risk for paraplegia i s presented.