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Progress and Future Challenges in Thoracoabdominal Aortic Aneurysm Management

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Abstract

Background

Postoperative paraplegia and paraparesis have been the scourge of thoracoabdominal aortic repair since the inception of the procedure.

Methods and Results

In our experience with more than 1,250 cases in 15 years, we have developed adjunctive strategies that have pushed neurologic deficit rates down from over 30% percent in the most extensive cases to less than 2% overall in the modern era. The dramatic reductions in risk reported by ourselves and others have led to recent complacency regarding the importance of this complication, and widening use of endovascular technologies raises the potential specter of a return to suboptimal results.

Conclusions

Utmost care is required in the vetting of these new technologies to prevent regression of the hard-won excellent results obtainable by open repair. Postoperative renal failure, in stark contrast to neurologic deficit, has remained resistant to every treatment that has been described in the literature. The fact that we haven’t learned to treat it means that we don’t understand the mechanisms behind it, and this problem is worthy of a major focused discovery and management effort. We have recently begun a multi-pronged research program to discover basic mechanisms of renal injury so that appropriate and effective treatments can be discovered.

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Acknowledgments

The authors are grateful to G. Ken Goodrick for editorial assistance, and to Chris Akers, who prepared the illustrations.

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Authors and Affiliations

  1. Department of Cardiothoracic and Vascular Surgery, The University of Texas at Houston Medical School, Memorial Hermann Heart and Vascular Institute, 6410 Fannin, Suite 450, Houston, Texas, 77030, USA

    Hazim J. Safi, Anthony L. Estrera, Ali Azizzadeh, Sheila Coogan & Charles C. Miller III

Authors
  1. Hazim J. Safi
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  2. Anthony L. Estrera
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  3. Ali Azizzadeh
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  4. Sheila Coogan
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  5. Charles C. Miller III
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Corresponding author

Correspondence to Hazim J. Safi.

Additional information

Presented at the conference Current and Future Trends in Cardiovascular Surgery, Chicago, Illinois, October 8, 2006

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Safi, H.J., Estrera, A.L., Azizzadeh, A. et al. Progress and Future Challenges in Thoracoabdominal Aortic Aneurysm Management. World J Surg 32, 355–360 (2008). https://doi.org/10.1007/s00268-007-9256-3

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  • DOI: https://doi.org/10.1007/s00268-007-9256-3

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