Indications. Urgent repair is indicated, except when precluded by more compelling life-threatening injuries or major central nervous system trauma.
Operative management. Using proximal and distal control, these aneurysms may be repaired by primary aortorrhaphy, aneurysmectomy, and end-to-end reanastomosis or by interposition grafting. Endovascular techniques have also been reported.
Possible complications of thoracic aortic surgery include
arrhythmia, myocardial infarction, intraoperative hemorrhage, stroke, aortic cross-clamp shock, renal insufficiency, lower-extremity ischemia, microemboli, and disseminated intravascular coagulopathy. The incidence of paraplegia may be as high as 30% with some types of (Ann Thorac Surg 2007;83:S856). This risk can be reduced by multimodal therapies implemented to prevent or minimize spinal cord ischemia: distal aortic perfusion, intercostal and lumbar artery reimplantation, preoperative or intraoperative localization of spinal blood supply, hypothermia, cerebrospinal fluid drainage, and pharmacotherapy.
