Experience with Ruptured Thoracoabdominal Aneurysms Involving the Visceral Arteries: Three-Year Experience in a Community Teaching Hospital—Case Reports

Abstract

Four patients (3 males and 1 female) with ruptured thoracoabdominal aneu rysms involving the visceral arteries were managed in a three-year period. Ages ranged from sixty-seven to eighty-two years. Two patients had freely ruptured aneurysms and were operated on emergently. Two patients had contained rup tures and were operated on urgently.

Hemodynamic monitoring consisting of Swan-Ganz catheters and arterial lines were employed in all patients. Exposure was obtained through a thoraco abdominal approach. A Gott shunt was employed in 1 patient. All patients re ceived intravenous heparin during aortic clamping, and protamine was rou tinely administered to reverse heparin. Standard techniques for vascular reconstruction were employed.

There was 1 intraoperative death in an eighty-two-year-old male who suf fered a cardiac arrest after replacement of thoracoabdominal aneurysm with reimplantation of the celiac axis.

Three patients survived operation. One patient developed paraplegia and expired forty days postoperatively. One patient had suture line bleeding that required reexploration. He is now alive and well three years postoperatively. The fourth patient did well postoperatively but died nine months after discharge from an acute myocardial infarction.

This study indicates that this difficult and life-threatening condition can be managed with satisfactory results even in the setting of a community teaching hospital.