Treatment of chronic expanding dissecting aneurysms of the descending thoracic and upper abdominal aorta by extended aortotomy, removal of the dissected intima, and closure.

PURPOSE: The incidence of complications, particularly paraplegia, remains high after surgical repair of DeBakey type IIIB chronic expanding dissecting aneurysms. In this report we cautiously advocate a new approach termed tailored aortoplasty, which allows the surgeon to achieve two primary goals: reduced renal/visceral and spinal cord ischemic time, and reperfusion of all patent inferior intercostal and superior lumbar arteries.

METHODS: Tailored aortoplasty consists of incising the controlled aorta on the left posterolateral surface from T-8 to the infrarenal portion. The membrane separating the true and false lumen is excised, and the aortotomy is closed to a diameter of 2 1/2 to 3 cm to reduce wall tension.

RESULTS: The procedure has been applied to 13 patients, all of whom survived, nine without complications. One patient had paresis after profound cardiogenic shock. Three patients had hemorrhage, one from an excluded intercostal artery, one from a delayed splenic rupture, and one from the suture line. He was the only patient treated for acute dissection with rupture.

CONCLUSIONS: Confining the procedure to chronic dissections, we found aortic tissues capable of holding sutures well, and there has been no expansion of the tailored segment on computed tomography or magnetic resonance imaging in mean follow-up of 2.1 years.