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Thoracoabdominal aneurysms

Thoracoabdominal aneurysms. Definition of aneurysm. Abnormal dilation of blood vessel Vessel Extent Type Fusiform Saccular Dissecting (Aorta) Aetiology. Dissecting aortic aneuysm. Dissection in an aortic aneurysm Aortic dissection that has subsequently become aneurysmal.

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Thoracoabdominal aneurysms

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  1. Thoracoabdominal aneurysms

  2. Definition of aneurysm • Abnormal dilation of blood vessel • Vessel • Extent • Type • Fusiform • Saccular • Dissecting (Aorta) • Aetiology

  3. Dissecting aortic aneuysm • Dissection in an aortic aneurysm • Aortic dissection that has subsequently become aneurysmal

  4. Classification of Thoracoabdominal aneurysms 1Crawford

  5. Classification of Thoracoabdominal aneurysms 2a DeBakey

  6. Classification of Thoracoabdominal aneurysms 2b Stanford / Daily

  7. Aetiology (Pathophysiology) • Atherosclerotic 90% • Mycotic or trauma 9% • Marfans, • Ehlers – Danlos, • Homocysteineuria, • Cystic medial necrosis

  8. Presentation • Incidental on CXR • Workup for other condition

  9. Investigations • Hx • Examination • Cardiac evaluation • ECG, • Not exercise test, • Angiography? CABG pre aneurysm • Aneurysm evaluation, • Echo (TOE), • CT, • MRI, • ? Aortography

  10. Diagnostic imaging CXR: Mediastinal widening

  11. AORTOGRAPHY - 1

  12. AORTOGRAPHY - 2

  13. AORTOGRAPHY - 3

  14. CT - 1

  15. CT - 2

  16. CT - 3

  17. MRI - 1

  18. MRI - 2

  19. MRI - 2

  20. ECHO (TOE)

  21. Indications for operation Symptomatic Acute enlargement Diameter twice normal aorta Mortality Elective 5 to 20 % Emergency 20 to 60 % Morbidity Paraplegia 4%

  22. Different operative approaches • Left incision (if exclude elephant trunk 1st step) • Distal perfusion • Cross clamp no circulatory support • Gott shunt • Partial CPB LA – Fem artery • Total CPB DHCA • Spinal cord protection • Reimplant intercostals T8 to L1 • Cross clamp less than 30 minutes • CSF drainage • Probably depends on the pathology and anatomy • Team effort

  23. Complications • Intraoperatively • Bleeding • Tissues falling apart • Left and right ventricular failure • Postoperatively • Bleeding • Paraplegia • Organ ischaemia • Renal failure

  24. CSF drainage • Early paraplegia • Late paraplegia

  25. Post operatively • Bleeding • Urine output • Gases • analgesia, • dilators, • bronchoscopy • BP management • Neurological

  26. Stenting

  27. Surgical Survival

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