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| Table 1 Crawford classification of patients with thoracoab-dominal aortic aneurysm |
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| Table 2 Reconstruction of abdominal branches (30 patients, 30/47 = 64%) |
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| Fig. 1 Selective perfusion system of visceral arteries during thoracoabdominal aortic aneurysm repair |
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| Table 3 Number of aortic segment in sequential aortic clamping technique |
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| Table 4 Number of reimplanted intercostal and lumbar arteries |
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Fig. 2 Performance of multi-segmental technique in the repair of a Crawford type II aneurysm.
Left: Preoperative aortogram.
Middle: Diagram show the aortic clamp sites. Note the close proximity of clamps.
Right: Diagram show graft in place and reattachment of four pair of intercostal arteries.
CA; Celiac artery, SMA; Superior mesenteric artery, LRA; Left renal artery |
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| Fig. 3 Use of saphenous vein graft for reimplantation of intercostal artery in patient with fragile aortic wall |
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Fig. 4 Late occlusion of left renal artery's graft is presented
Left: Angiogram show good functioning of aortic and four middle size grafts for abdominal branches (celiac, superior mesenteric and bilateral renal arteries) one month after the graft replacement for mycotic Type IV thoracoabdominal aortic aneurysm.
Right: Occlusion of left renal artery's graft is observed on angiogram two years after the operation. |
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T; Intercostal artery, L; Lumbar artery
Fig. 5 Extent and No. of reimplanted arteries |
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| Table 5 Identification of anterior spinal arteries on postoperative angiogram |
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| Fig. 6 The characteristic appearance of anterior spinal artery on selective postoperative angiogram through reimplanted T11 intercostal artery (in patient No. 2 in Table 5) . Note the typical hairpin turn of anterior spinal artery and presence of numerous collateral vessels. |
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Fig. 7 Late aneurysm involvement of reattached aortic wall is presented
a and b: Aortogram and diagram made before first operation showing location of aneurysm.
c and d: Aortogram and diagram made after the operation showing graft in place and functioning.
e: Development of aneurysm of reattached aortic wall is shown 11 years after the surgery. |
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Fig. 8 Left: intraoperative view of second operation (graft replacement) for aneurysm formation of reattached aortic wall in the patient Fig 7. Note the use of saphenous vein for T8 intercostal artery's reimplantation.
Right: Aortogram shows graft in place after the second operation. |
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Fig. 9 Diagram of current idea for reimplantation of intercostal or lumbar arteries.
Left: If, restoration of circulation to reattached arteries give good back flow to adjasent distal artery, this artery need not reimplantation. On, contrary, the artery should be reimplanted when the back flow is poor.
Right: However, the artery should be preserved till to the end of operation (preservation technique) , whenever reimplantation of this artery can be done observing the late change of SEP or MEP monitoring. |
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