Reoperative aortic surgery.

Details

Serval ID
serval:BIB_1416FF917DDE
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Reoperative aortic surgery.
Journal
Cardiovascular Surgery
Author(s)
Matsumura J.S., Pearce W.H., Cabellon A., McCarthy W.J., Yao J.S.
ISSN
0967-2109
Publication state
Published
Issued date
1999
Peer-reviewed
Oui
Volume
7
Number
6
Pages
614-621
Language
english
Abstract
The presentation of long-term complications after conventional aortic surgery and the treatment of patients that have had reoperative aortic operations are reviewed. Ninety-seven consecutive patients that had 102 subsequent aortic operations at a tertiary referral center were studied. Presenting symptoms, demographics, risk factors, indications for initial and second procedures, operative techniques and outcomes were recorded in a computerized database. There were 70 men and 27 women studied, with an average age of 64 years. First operations were performed primarily for aneurysm (56%) and occlusive disease (44%). The interval between procedures ranged up to 23 years, with a mean of 6 years. Indications for reoperation were subsequent aneurysm (65), graft occlusions (25) and/or infections (24). Seventy-three percent of the subsequent aneurysms were true metachronous aneurysms; the others were associated with the graft or an anastomosis. Para-anastomotic aneurysms may be more common with a primary end-to-side graft configuration. One-third of subsequent aneurysms were not palpable and asymptomatic. Graft occlusion can be treated safely with elective repeat bypass (mortality 0%). Graft infections that require total graft removal remain a challenging problem (mortality 17%). Although surgical approach for reoperations utilized more extensive exposure and proximal clamping, 59 elective aneurysm cases had a 5.1% mortality rate; eight emergent procedures for ruptured aneurysms resulted in 88% mortality. Reoperation for graft occlusion or infection showed a similar high mortality rate with emergent cases. In this referral practice, graft occlusion and infection are relatively less frequent, whereas metachronous aneurysm formation is now the most common indication for reoperation. These aneurysms often remain undetected until symptoms occur; frank rupture is usually lethal. As elective repair with modern reoperative techniques can be safely performed, routine computed tomographic examination is advisable at least every 5 years after aortic operations.
Keywords
Aortic Aneurysm, Abdominal/surgery, Aortic Diseases/surgery, Arterial Occlusive Diseases/surgery, Blood Vessel Prosthesis/adverse effects, Female, Follow-Up Studies, Graft Occlusion, Vascular/surgery, Humans, Male, Middle Aged, Prosthesis-Related Infections/surgery, Reoperation, Time Factors
Pubmed
Web of science
Create date
14/02/2008 14:15
Last modification date
20/08/2019 12:42
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