Open aortic repair up to previous abdominal aortic surgery.

Background: To determine whether direct open repair of thoracoabdominal aortic aneurysms after previous abdominal aortic surgery is a safe option.

Methods: Ten patients were operated between January 2006 and January 2012. Mean age was 70 years (62-78 years). Four aneurysms (Crawford type III) were treated by firstly performed bypasses from the upper thoracic aorta to the celiac trunk, the superior mesenteric artery, and the left renal artery. Secondly performed aortic repair included revascularization of intercostal arteries identified as critical for spinal cord and the right renal artery. Similarly, the 6 aneurysms (Crawford type IV) were treated by firstly performed bypass from the upper thoracic aorta to the left renal artery before aortic repair.

Results: The overall mortality and paraplegia rates were nil. The maximal creatinin sera variation was 48 ± 16% with return to the baseline level before discharge. Five patients presented with pulmonary complications. The duration of stay was 9.3 days (2-29) in the intensive care unit and 24 days (10-40) in the surgical unit. The mean follow-up was 35 months. No patient died during the follow-up.

Conclusions: In our experience, open redo aortic surgery appears to be safe. The main relevant point is the sequential reconstruction of the aorta including bypasses of the visceral branches that lowered the visceral ischemic damage because of high level aortic cross-clamping.