Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1978 Sep;188(3):404–421. doi: 10.1097/00000658-197809000-00016

Progress in Treatment of Thoracoabdominal and Abdominal Aortic Aneurysms Involving Celiac, Superior Mesenteric, and Renal Arteries

E Stanley Crawford, Donald M Snyder, Gwen C Cho, John O F Roehm Jr
PMCID: PMC1396963  PMID: 686902

Abstract

This is a report of surgical treatment of thoracoabdominal aortic aneurysms and aneurysms of the abdominal aorta from which the visceral vessels arise during the 18 year period from April 5, 1960, to April 20, 1978. The extent of aneurysm is divided into five groups. Group I (10 patients) involved most of the thoracic and abdominal aorta down to celiac axis. Group II (22 patients) involved most of the thoracic and abdominal aorta distal to left subclavian artery. Group III (20 patients) were those with lesser involvement of the thoracic aorta and most of the abdominal aorta. Group IV (18 patients) with involvement of the entire abdominal aorta and Group V (12 patients) with involvement of lower abdominal aorta and renal arteries. Treatment in the majority of these cases was by graft inclusion technique with visceral vessel reattachment by direct suture of orifice to openings made in the graft. Intercostal and/or lumbar arteries were also reattached in some with the more extensive lesions. Aortic and renal artery occlusion times varied from 15 to 155 minutes. Paraplegia developed in five patients with the more extensive lesions but was reduced to one-third and made less severe by reattaching intercostal and lumbar arteries. Renal dysfunction was mild in four patients and severe in three patients after operation. All these were transient except one who died while recovering from renal failure. The latter cases were those difficult to reattach or were not initially successful and required reoperation. Of the 82 patients, 77 (94%) survived operation and long-term followup was obtained in 95% of cases, 23 performed over five years ago. Actuarial curves were constructed and compared to survival curves following simple infrarenal abdominal aortic resection. The survival rate both immediately and at six years, were the same.

Full text

PDF
421

Images in this article

406Fig. 2.
on p.406
407Fig. 3.
on p.407
408Fig. 4.
on p.408
408Fig. 4.
on p.408
409Fig. 5.
on p.409
409Fig. 6.
on p.409
410Fig. 7a.
on p.410
410Fig. 7b.
on p.410
411Fig. 8.
on p.411
412Fig. 9a.
on p.412
412Fig. 9b.
on p.412
413Fig. 10.
on p.413
413Fig. 10b.
on p.413
413Fig. 10c.
on p.413
414Fig. 11.
on p.414
414Fig. 12.
on p.414
416Fig. 15.
on p.416
416Fig. 15c.
on p.416
417Fig. 16a-d.
on p.417
417Fig. 16e-h.
on p.417
418Fig. 18a,b.
on p.418
419Fig. 18c.
on p.419

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bosher L. H., Jr, Brooks J. W. The surgical treatment of thoracoabdominal aneurysms and aneurysms of the upper abdominal aorta. Va Med Mon (1918) 1975 Feb;102(2):116–124. [PubMed] [Google Scholar]
  2. Brawley R. K., Fisher R. D., DeMeester T. R., Elkins R. C. Deliberate renal ischemia. A valuable and safe adjunct during operations upon the abdominal aorta. Ann Thorac Surg. 1972 Apr;13(4):356–363. doi: 10.1016/s0003-4975(10)64867-9. [DOI] [PubMed] [Google Scholar]
  3. CRAWFORD E. S., DE BAKEY M. E., BLAISDELL F. W. Simplified treatment of large, sacciform aortic aneurysms with patch grafts. Experiences with 5 cases. J Thorac Cardiovasc Surg. 1961 Apr;41:479–491. [PubMed] [Google Scholar]
  4. Crawford E. S., Morris G. C., Jr, Myhre H. O., Roehm J. O., Jr Celiac axis, superior mesenteric artery, and inferior mesenteric artery occlusion: surgical considerations. Surgery. 1977 Dec;82(6):856–866. [PubMed] [Google Scholar]
  5. Crawford E. S., Rubio P. A. Reappraisal of adjuncts to avoid ischemia in the treatment of aneurysms of descending thoracic aorta. J Thorac Cardiovasc Surg. 1973 Nov;66(5):693–704. [PubMed] [Google Scholar]
  6. Crawford E. S. Thoraco-abdominal and abdominal aortic aneurysms involving renal, superior mesenteric, celiac arteries. Ann Surg. 1974 May;179(5):763–772. doi: 10.1097/00000658-197405000-00032. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. DEBAKEY M. E., CRAWFORD E. S., COOLEY D. A., MORRIS G. C., Jr, ROYSTER T. S., ABBOTT W. P. ANEURYSM OF ABDOMINAL AORTA ANALYSIS OF RESULTS OF GRAFT REPLACEMENT THERAPY ONE TO ELEVEN YEARS AFTER OPERATION. Ann Surg. 1964 Oct;160:622–639. doi: 10.1097/00000658-196410000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. DEBAKEY M. E., CREECH O., Jr, MORRIS G. C., Jr Aneurysm of thoracoabdominal aorta involving the celiac, superior mesenteric, and renal arteries; report of four cases treated by resection and homograft replacement. Ann Surg. 1956 Oct;144(4):549–573. doi: 10.1097/00000658-195610000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. De Bakey M. E., Beall A. C., Jr, Cooley D. A., Crawford E. S., Morris G. C., Jr, Garrett H. E. Resection and graft replacement of aneurysms involving the transverse arch of the aorta. Surg Clin North Am. 1966 Aug;46(4):1057–1071. doi: 10.1016/s0039-6109(16)37946-6. [DOI] [PubMed] [Google Scholar]
  10. DeBakey M. E., Crawford E. S., Garrett H. E., Beall A. C., Jr, Howell J. F. Surgical considerations in the treatment of aneurysms of the thoraco-abdominal aorta. Ann Surg. 1965 Oct;162(4):650–662. doi: 10.1097/00000658-196510000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. DeBakey M. E., Crawford E. S., Garrett H. E., Beall A. C., Jr, Howell J. F. Surgical considerations in the treatment of aneurysms of the thoraco-abdominal aorta. Ann Surg. 1965 Oct;162(4):650–662. doi: 10.1097/00000658-196510000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. ELLIS F. H., Jr, HELDEN R. A., HINES E. A., Jr Aneurysm of the abdominal aorta involving the right renal artery: report of case with preservation of renal function after resection and grafting. Ann Surg. 1955 Dec;142(6):992–996. doi: 10.1097/00000658-195512000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. ETHEREDGE S. N., YEE J., SMITH J. V., SCHONBERGER S., GOLDMAN M. J. Successful resection of a large aneurysm of the upper abdominal aorta and replacement with homograft. Surgery. 1955 Dec;38(6):1071–1081. [PubMed] [Google Scholar]
  14. Hardy J. D., Timmis H. H., Saleh S. S., Hardin W. J. Thoracoabdominal aortic aneurysm: simplified surgical management with case report. Ann Surg. 1967 Dec;166(6):1008–1011. doi: 10.1097/00000658-196712000-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. JAVID H., JULIAN O. C., DYE W. S., HUNTER J. A. Complications of abdominal aortic grafts. Arch Surg. 1962 Oct;85:650–662. doi: 10.1001/archsurg.1962.01310040122014. [DOI] [PubMed] [Google Scholar]
  16. Lefrak E. A., Crawford E. S. Thoracoabdominal aneurysm after resection and dacron graft replacement of the descending thoracic aorta. Ann Surg. 1972 Dec;176(6):765–768. doi: 10.1097/00000658-197212000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. McCaughan J. J., Jr, Eastridge C. E. A new technique for resection of thoracoabdominal aneurysms. Am Surg. 1975 Oct;41(10):611–614. [PubMed] [Google Scholar]
  18. Nunn D. B., Dupree E. L., Renard A. A new method for preserving the kidney during aortic grafting and reimplantation of renal arteries. Surg Gynecol Obstet. 1974 Dec;139(6):923–927. [PubMed] [Google Scholar]
  19. Parsonnet V., Sy R., Alpert J., Brief D. K. Replacement of the thoraco-abdominal aorta. J Med Soc N J. 1969 Sep;66(9):510–512. [PubMed] [Google Scholar]
  20. Pollock H., Johnson G., Jr Effect of acute occlusion of the infrarenal aorta on renal function. Surg Gynecol Obstet. 1973 Nov;137(5):805–809. [PubMed] [Google Scholar]
  21. Powis S. J. Renal function following aortic surgery. J Cardiovasc Surg (Torino) 1975 Nov-Dec;16(6):565–571. [PubMed] [Google Scholar]
  22. SPENCER F. C., ZIMMERMAN J. M. The influence of ligation of intercostal arteries on paraplegia in dogs. Surg Forum. 1958;9:340–342. [PubMed] [Google Scholar]
  23. Shumacker H. B., Jr Innovation in the operative management of the thoracoabdominal aortic aneurysm. Surg Gynecol Obstet. 1973 May;136(5):793–794. [PubMed] [Google Scholar]
  24. Spanos P. K., Mozes M. M., Najarian J. S. Resection of suprarenal aortic aneurysm with autotransplantation of the kidney. Ann Surg. 1974 Dec;180(6):823–826. doi: 10.1097/00000658-197412000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Stoney R. J., Wylie E. J. Surgical management of arterial lesions of the thoracoabdominal aorta. Am J Surg. 1973 Aug;126(2):157–164. doi: 10.1016/s0002-9610(73)80147-3. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES