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Master Thesis

Résultats de la chirurgie ouverte des anévrismes complexes de l'aorte abdominale

Abstract : The objective was to evaluate the' morbidity and mortality of open repair for supra-renal and type IV thoracoabdominal aortic aneurysms (TAA).
Material and. Methods:
This single-center retrospective observational study consecutively included all patients operated from 2000 to 2021 for supra-renal aneurysm or IV TAA. The approaches were retroperitoneal +/- a complete phrenotomy. The digestive arteries and the right renal were integrated into the proximal aortic anastomosis. The left renal artery (LRA) was revascularized by anterograde, retrograde bypass or direct reimplantation. The primary endpoint was 30-day mortality. Secondary endpoints assessed in-hospital mortality, morbidity, and long-term survival. Respiratory failure was defined as intubation >24h, reintubation, or use of NIV. Statistical analyses were performed using a Mann Whitney test or Fisher test.
Results:
One hundred and twelve patients, mean age 68 years, were included with a mean ASA score of 2.7. LRA revascularization was anterograde (A: 31.5%), retrograde (R: 59.5%) or direct (D: 9%). The clamping times of the digestive, right and LRA were 28, 30 and 49 min, respectively. One death at 30 days from respiratory distress (0.9%). One paraplegia (0.9%). Thirty-seven patients (33%) developed respiratory failure. The occurrence of respiratory failure was not different according to whether a complete phrenotomy was performed or not (p=0.84), nor according to the type of LRA revascularization (p=0.27). In-hospital mortality was higher in patients with respiratory failure (p=0.03). Thirty-three patients (30%) had KDIGO AKI > II. Patients with KDIGO AKI > II had higher right and left renal ischemia durations (p<0.01). The occurrence of KDIGO AKI > II, was different according to the type of LRA revascularization (A: 5/36; R: 22/66 and D:6/10; p<0.01). In-hospital mortality was higher in patients with KDIGO LRA > II (p=0.03). Five patients (4.5%) were dialyzed immediately postoperatively, only in the retrograde/direct bypass groups. The median survival was 12 years. It was different according to the type of LRA revascularization (p=0.03).
Conclusion:
The morbi-mortality of open repair of supra-renal aneurysms and IV TAA is pulmonary. It was not increased by phrenotomy or anterograde LRA repair.
Document type :
Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03526912
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Submitted on : Friday, January 14, 2022 - 6:13:35 PM
Last modification on : Tuesday, February 8, 2022 - 3:30:58 AM
Long-term archiving on: : Friday, April 15, 2022 - 7:19:43 PM

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  • HAL Id : dumas-03526912, version 1

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Mickael Palmier. Résultats de la chirurgie ouverte des anévrismes complexes de l'aorte abdominale. Médecine humaine et pathologie. 2021. ⟨dumas-03526912⟩

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