Thoracoabdominal aneurysms - PowerPoint PPT Presentation

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Thoracoabdominal aneurysms

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Aortic dissection that has subsequently become aneurysmal ... Diagnostic imaging. CXR: Mediastinal widening. AORTOGRAPHY - 1. AORTOGRAPHY - 2. AORTOGRAPHY - 3 ... – PowerPoint PPT presentation

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Title: Thoracoabdominal aneurysms


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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