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Japanese perspective in surgery for thoracoabdominal aortic aneurysms

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Title: Japanese perspective in surgery for thoracoabdominal aortic aneurysms
Authors: Shiiya, Norihiko Browse this author
Washiyama, Naoki Browse this author
Tsuda, Kazumasa Browse this author
Yamanaka, Ken Browse this author
Takahashi, Daisuke Browse this author
Yamashita, Katsushi Browse this author
Natsume, Kayoko Browse this author
Takeuchi, Yuki Browse this author
Kubota, Suguru Browse this author
Matsui, Yoshiro Browse this author →KAKEN DB
Keywords: Thoracoabdominal aortic aneurysm
Spinal cord protection
Open surgical repair
Issue Date: Jan-2019
Publisher: Springer
Journal Title: General thoracic and cardiovascular surgery
Volume: 67
Issue: 1
Start Page: 187
End Page: 191
Publisher DOI: 10.1007/s11748-017-0838-1
Abstract: Objective: Operative mortality and morbidity after thoracoabdominal aortic surgery remain high. We report our strategy and outcomes, especially those of spinal cord protection. Methods: Outcomes of 178 patients (age: 26-88 years) who underwent thoracoabdominal aortic replacement were retrospectively analyzed. 65 had aortic dissection, 14 had infected aneurysms, and 22 presented with rupture. Operations were non-elective in 24 and redo through re-thoracotomy in 21. Extent of replacement was Crawford-I in 39, II in 26, III in 78, and IV in 35. Staged repair was recently preferred, which resulted in decrease in extent II repair and increase in redo since 2009. Operations were performed under distal aortic perfusion and multi-segmental sequential repair to maximize collateral blood flow, and deep hypothermic circulatory arrest was preserved for those requiring open aortic anastomosis (n = 20). A total of 166 separate grafts were used for intercostal reconstruction in 88 patients, which was guided by preoperative feeding artery localization. Their patency was studied by postoperative MD-CT in 74 patients for 145 grafts. Results: There were 3.9% hospital mortality and 5.1% spinal cord injury. Preoperative feeding artery localization resulted in reduced number of reconstruction and improved patency, and grafts connecting to the feeding artery were patent in 92%. Results of redo operations were not different (no mortality and spinal cord injury) from the de novo operations. Conclusions: Our concept of spinal cord protection, which was based on selective intercostal reconstruction while maximizing spinal cord collateral blood flow, seems justified.
Rights: The final publication is available at
Type: article (author version)
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 松居 喜郎

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