Thoracic aortic aneurysmectomy
When is this procedure indicated?
This procedure is indicated in aneurysms, pseudoaneurysms associated with aortic coarctation and dissections involving the thoracic aorta with variable extension. These pathologies require replacement of the aorta in the thoracic tract; the main purpose of the procedure is to eliminate the risk of rupture of the aneurysm and/or the risks associated with the presence of aortic coarctation (hypertension, malperfusion) and with aortic dissections of the thoracic tract (cerebral and/or medullary malperfusion). This procedure can also be used in cases of surgical conversion after previous endovascular procedures, when the latter are complicated by endoleak (reperfusion of the aneurysmal sac) or endoprosthesis infection.
How is it performed?
The intervention consists in the replacement of the stretch of aorta affected by pathology with a prosthesis made of biocompatible material. The surgical technique, depending on the extent of pathology and the individual risk of the patient, makes use of some anesthesia to protect the spinal cord, vascularized by the stretch of aorta that will be replaced (drainage of CSF). The intervention involves the following steps:
incision of the chest wall (between the ribs);
release of the diseased aorta from adhesions with the surrounding tissues. This phase can be very delicate because of the delicate relationships of the aorta to the thoracic level (lungs, nerves, diaphragm, etc. ..);
closing (clamping) of the aorta proximally and distally to the diseased section and beginning of the strategies of monitoring, perfusion and drainage;
replacement of the diseased aorta with dedicated prosthesis;
completion of the suture between prosthesis and aorta and reconstruction of all vessels arising from the latter (if indicated, intercostal arteries).
After discharge, a patient still needs a 2 week convalescence period at home or rehabilitation before fully resuming his/her previous activities. During this period, it is normal to feel rather weak, not having appetite. In this period it is important to resume physical activity gradually, first with the help of physiotherapy and then trying, in progressive autonomy, to take short walks, with the aim of doing every day something more than the previous day.
Complications following such a major surgery are still frequent; they may be less impactful in the long term, such as surgical wound infections, or urinary and respiratory infections, but they can also be very serious, resulting in stroke, spinal cord ischemia with transient/permanent paraplegia, hemorrhage, re-interventions, respiratory or cardiovascular failure. Mortality for this type of surgery, despite technical progress, is still around 10%.
These are the data related to the complications observed in our Aortic Center, reference center for these pathologies at national level.
Long-term complications include: surgical wound infection causing dehiscence, requiring advanced dressings for healing by second intention; pseudoaneurysms; prosthesis infection.