Simple Clamping and Temporary Bypass for Surgery of the Descending Thoracic Aorta

Abstract

Descending thoracic aortic aneurysms are usually repaired with adjunctive techniques to maintain distal perfusion for the prevention of organ ischemia. The authors have developed a simple technique for this purpose, in which combined simple aortic clamping and temporary bypass were used. The proximal anastomosis was performed with simple aortic clamping, while the distal anastomosis was performed under temporary bypass, which had been anastomosed between the aortic graft and the left femoral artery. This technique was used in four patients. The mean duration of simple aortic clamping was 9 minutes (range:7 to 12 minutes). All patients were discharged without complications. This technique is simple, safe, and less expensive in selected patients.

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References

1. Roberts AJ , Michaelis LL : The use of bypass techniques and other forms of organ protection during thoracic aortic cross-clamping. In: Surgery of the Aorta and Its Body Branches, ed. by Bergan JJ , Yao JST . New York: Grune and Stratton, 1979, pp 109-127.

2. Crawford ES , Rubio PA : Reappraisal of adjuncts to avoid ischemia in the treatment of aneurysms of descending thoracic aorta. J Thorac Cardiovasc Surg 66:693-704, 1973.

3. Svensson LG , Crawford ES , Hess KR , et al: Variables predictive of outcome in 832 patients undergoing repairs of the descending thoracic aorta. Chest 104:1248-1253, 1993.

4. Crawford ES , Walker HSJ , Saleh SA , et al: Graft replacement of aneurysm in descending thoracic aorta: Results without bypass or shunting. Surgery 89:73-85, 1981.

5. Symbas PN , Pfaender LM , Drucker MH , et al: Crossclamping of the aorta: Hemodynamic and neurohumoral effects. J Thorac Cardiovasc Surg 85:300-305, 1983.

6. Crawford ES , Miarahi EM , Hess KR , et al: The impact of distal aortic perfusion and somatosensory evoked potential monitoring on prevention of paraplegia after aortic aneurysm operation. J Thorac Cardiovasc Surg 95:357-367, 1988.

7. Adams HD , van Geertruyden HH : Neurologic complications of aortic surgery. Ann Surg 144:574-610, 1956.

8. Livesay JJ , Cooley DA , Ventemiglia RA , et al: Surgical experience in descending thoracic aneurysmectomy with and without adjuncts to avoid ischemia. Ann Thorac Surg 39:37-46, 1985.

9. Lawrie GM , Earle N , DeBakey ME : Evolution of surgical techniques for aneurysms of the descending thoracic aorta: Twenty-nine years experience with 659 patients. J Card Surg 9:648-661, 1994.

10.

10. Svensson LG , Coselli JS , Safi HJ , et al: Appraisal of adjuncts to prevent acute renal failure after surgery on the thoracic or thoracoabdominal aorta. J Vasc Surg 10:230-239, 1989.

11.

11. Tada Y , Kamiya K , Shindo S , et al: Surgical management of atherosclerotic aneurysms of the distal aortic arch using a temporary bypass graft method. Yamanashi Med J 10:111-119, 1995.