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Descending and Thoracoabdominal Aorta
Surgery for aneurysm of the descending and thoracoabdominal aorta typically involves older, higher risk patients who may have hypertension, atherosclerosis, pulmonary obstructive disease (COPD), a history of smoking and some degree of existing kidney disease.
Surgical Procedures (Descending and Thoracoabdominal Aorta)
There are several techniques for surgery on this segment of the aorta. The "clamp and sew" method is the simplest, fastest approach. It is used at Cedars-Sinai to treat trauma cases only. Currently for elective surgery of the descending and thoracoabdominal aorta, the Cedars-Sinai procedure involves total circulatory arrest. Regardless of the technique used, the main consideration in surgery of the descending and thoracoabdominal aorta is always spinal cord and kidney protection.
- "Clamp and Sew" Method
- Partial Cardiopulmonary Support (Partial Heart-Lung Machine)
- Left Heart Bypass
- Total Circulatory Arrest Technique
This technique has the advantages of simplicity, and there is less chance of coagulation problems. It is the fastest technique, but also has the highest complication rate for: paraplegia, renal failure and embolization of sclerotic material to the visceral organs, lower extremities and kidneys. This is the preferred approach for trauma patients in which the aorta has been torn. The acceptable time limit for this procedure is 30 minutes. At Cedars-Sinai this technique, when performed on trauma cases, is typically completed within 25 minutes.
With this technique cannula are placed through the femoral vein and artery. A full dose of heparin is used, and the aorta is still clamped. This approach provides some protection to the spinal cord and kidneys. This technique is rarely used at Cedars-Sinai.
In this approach the patient's own lungs continue to function. Only the heart is bypassed. This technique can therefore be done with a low dose of heparin. Similar to the partial cardiopulmonary approach, there is risk of atherosclerotic embolization. At Cedars-Sinai this technique was used prior to 1994, but is not currently performed. It has been replaced by a TCA and no-clamp technique.
At Cedars-Sinai Medical Center, the total circulatory arrest technique has been used since 1994. This technique has minimized the risk of embolization while also providing maximum spinal cord protection. Through the use of this technique, renal failure became extremely unlikely, and the risks of paraplegia and postsurgical mortality dramatically reduced. (Please see Outcomes for details.)