Transverse Arch and Descending Type I Thoracoabdominal Aneurysm 

Author: Jason Smith, MD; Matthew Sweet, MD; Nahush Mokadam, MD; Edward Verrier, MD
Institution: University of Washington
Date Reviewed: September 2015
Learning Domain: Adult Cardiac Surgery
Learning Objective: Great Vessel Surgery
PowerPoint File: Transverse Arch and Descending Type I Thoracoabdominal Aneurysm

 

Discussion Points

  • Diagnostic Priorities
    • Best imaging
    • Genetics?
  • How would you handle this problem?
  • Timing on Interventions
    • Emergent / Urgent / Elective
    • Staged?
  • Therapeutic goals / options
    • Endovascular vs Open vs Hybrid
    • Landing zones
    • Use of CPB / DHCA / Cerebral protection

 

Key Points in Spinal Protection

  • Hypothermia
    • DHCA
    • Moderate hypothermia with LHBP
    • Mild hypothermia with native circulation
  • Staged Procedures
    • For extensive aneurysm
  • Spinal Fluid Drainage
  • Neuromonitoring
    • MEPs, SSEPs and NIRS

 

Learning Points

  • Not all collagen vascular disease are known or understood
  • Hybrid options  are  often necessary when approaching complex TAA
  • Spinal Cord protection better with staged TAA procedures
  • Hinge point for rupture:
    • 6 cm ascending
    • 7.0 cm descending
  • Debranching of the cerebral and visceral vessels often challenging
  • Endovascular Technology evolving rapidly
  • Small endo-graft leaks common 
  • Close follow up essential