Whitlock Richard S, Coselli Joseph S
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX USA.
Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, One Baylor Plaza, BCM 390, Houston, TX USA.
Indian J Thorac Cardiovasc Surg. 2019 Jun;35(Suppl 2):179-185. doi: 10.1007/s12055-018-0757-5. Epub 2018 Dec 14.
Open repair of a thoracoabdominal aortic aneurysm (TAAA) is an extensive operation and associated with significant perioperative morbidities and mortality, in large part due to distal aortic ischemia secondary to aortic cross-clamping that is necessitated during repair. Distal aortic ischemia may manifest as complications of the kidneys and viscera. Postoperative renal complications range from temporarily elevated levels of creatinine resulting from impaired kidney function to acute renal failure necessitating dialysis that may persist after hospital discharge. Continued advances in the management and adjuncts associated with TAAA repair since the groundbreaking era of E.S. Crawford have led to improved postoperative outcomes following surgery, but the dramatic improvements seen in reducing rates of spinal cord deficits, mesenteric ischemia and other serious postoperative complications have not been seen in contemporary rates of postoperative renal failure. We provide an overview of the various surgical techniques and adjuncts as they relate to the management of visceral and renal ischemia.
胸腹主动脉瘤（TAAA）开放修复术是一项大型手术，与显著的围手术期发病率和死亡率相关，这在很大程度上是由于修复过程中必须进行主动脉交叉钳夹导致远端主动脉缺血。远端主动脉缺血可能表现为肾脏和内脏的并发症。术后肾脏并发症范围从肾功能受损导致的肌酐水平暂时升高到需要透析的急性肾衰竭，且这种情况可能在出院后仍持续存在。自E.S. 克劳福德开创先河的时代以来，TAAA修复相关的管理和辅助手段不断进步，使得术后结果有所改善，但在降低脊髓缺损、肠系膜缺血和其他严重术后并发症发生率方面取得的显著进展，在当代术后肾衰竭发生率中并未体现。我们概述了与内脏和肾脏缺血管理相关的各种手术技术和辅助手段。
