06 Experience with 1509 Patients Undergoing Thoracoabdominal Aortic Operations скачать в хорошем качестве

06 Experience with 1509 Patients Undergoing Thoracoabdominal Aortic Operations

#TAAA #AorticAneurysm #VascularSurgery #CrawfordClassification #MedicalResearch #SurgicalOutcomes #SpinalCordIschemia #KidneyFunction #Healthcare #Surgery This video discusses the landmark 1993 paper "Experience with 1509 Patients Undergoing Thoracoabdominal Aortic Operations" by Svensson and Crawford. This study was the first comprehensive analysis of open surgical repair for thoracoabdominal aortic aneurysms (TAAAs), a complex procedure involving the aorta in both the chest and abdomen. The study, a retrospective cohort analysis of patients treated between 1960 and 1991 using the clamp and sew technique, aimed to identify factors linked to early death and complications. Analysing data from 1,509 patients undergoing their first TAAA repair, the researchers tracked outcomes for up to 10 years. Key findings revealed strong predictors of early death, including increasing age, poor pre-existing kidney function, chronic lung disease, coronary artery disease, concurrent proximal aneurysms, and increased aortic clamp time. Postoperative complications like stroke, cardiac issues, renal failure, or gastrointestinal problems also indicated a higher risk of early death. A major focus was spinal cord ischemia, the most feared complication. The study found links between its risk and increased aortic cross clamp time, visceral ischemic time, ruptured aneurysms, patient age, pre-existing kidney problems, and concurrent proximal aneurysms. The paper also contributed to understanding this risk based on the extent of the aneurysm using the Crawford classifications. Protecting or reattaching intercostal arteries was highlighted as important. Notably, baseline kidney function showed a surprisingly strong link to long-term survival, even more so than spinal cord ischemia or aortic dissection. Predictive factors for postoperative renal failure included baseline kidney function, atherosclerotic disease, renal arterial occlusive disease, higher pre-surgery creatinine levels, and visceral ischemic time. Despite being retrospective, the study's large scale and analysis of the dominant surgical method of the era made it a crucial benchmark, highlighting the surgery's difficulties and motivating research into preventing spinal cord ischemia. This paper paved the way for current protective strategies like cerebrospinal fluid drainage and distal aortic perfusion. Dr. Crawford's work remains a standard for evaluating advancements in the field.