Repair of Extensive Thoracoabdominal Aortic Aneurysm with a Tetrafurcate Graft: Midterm Results of 63 Cases
Objective: The objective is to present a method for maintaining the spinal cord blood supply and our midterm results for using a tetrafurcate graft in extensive thoracoabdominal aortic aneurysm (TAAA) repair.
Methods: From August 2003 to October 2007, we used a tetrafurcate graft to perform repairs to TAAAs of Crawford extent II in 63 consecutive patients. The mean age of this group of patients was 39.98 ± 10.62 years, and 46 (73%) of them were male. All of the procedures were performed under profound hypothermia with a short interval of circulatory arrest. T6 to T12 intercostal arteries were reconstructed as a "neo-intercostal artery" (N-IA) and were connected to an 8-mm sidearm of the graft to maintain the spinal cord blood supply. Visceral arteries were joined into a patch and were anastomosed to the end of the main graft. The left renal artery was anastomosed to an 8-mm sidearm or joined to the patch. The other 10-mm sidearms were anastomosed to iliac arteries.
Results: With 100% follow-up, the early-mortality rate was 7.94%. The incidence of cerebral complications was 9.52%. Temporary paraplegia was observed in 2 patients, and paraparesis occurred in 1 patient. Pulmonary complication was the most common morbidity in this group (25.40%). Two patients with Marfan syndrome had N-IA artery pseudoaneurysms during follow-up. The mean survival time of this group was 50.64 ± 2.13 months, with survival rates of 92.06% after 1 year, 88.38% after 2 years, and 86.11% after 3 years.
Conclusion: The N-IA may play an important role in spinal cord protection, and N-IA pseudoaneurysm should be avoided in Marfan syndrome patients. The use of a tetrafurcate graft is a reliable method for TAAA repair, with satisfactory midterm results.
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