Thoracoabdominal aortic aneurysmectomy in the high-risk patient.

Overview

OBJECTIVE: The study objective was to provide a review of outcomes and management strategies for high-risk scenarios in the open repair of thoracoabdominal aortic aneurysms. METHODS: Series examining the open repair of thoracoabdominal aortic aneurysms were reviewed to identify well-described high-risk scenarios and summarize expected outcomes and management strategies in the current era. RESULTS: The efforts of many have led to improved outcomes for patients undergoing the inherently challenging open repair of thoracoabdominal aortic pathologies. Several well-described high-risk scenarios include those related to preoperative comorbid conditions (preoperative pulmonary dysfunction, low ejection fraction, and renal dysfunction), anatomically high-risk cases (extent II repairs), and those with acute presentations (rupture, mycotic aneurysms, acute complicated type B aortic dissection). Several operative and perioperative techniques have been developed to mitigate the risk in these formidable cases. CONCLUSIONS: Challenges remain for several high-risk scenarios in thoracoabdominal aortic aneurysm repair. Judicious patient selection, meticulous surgical, and critical care strategies have greatly decreased the risk for many high-risk patients.