Prevention of complications in the surgery of thoracic and thoracoabdominal aorta

The care of patients with descending and thoracoabdominal aneurysms has improved to the extent that the 30-day survival rate is of 95-96% in various reports. Nevertheless, in those high-risk patients with Crawford Type I or Type II thoracoabdominal aneurysms the possibility of developing complications such as paraplegia, paraparesis, acute kidney failure or respiratory impairment remains high. Various techniques have been attempted to clinically reduce the incidence of paraplegia and paresis in some of these appear to have a protective effect. With new approaches, the incidence of renal failure (about 5%) requiring dialysis has been reduced. Respiratory complications remain a problem because of the extensive nature of thoracoabdominal aneurysm repair, altough, this is largely determinated by the patient's preoperative status. In this article the Authors discuss, on their experience, the risks of injury to the spinal cord, the kidneys and the mesenteric circulation during repair of thoracic and thoracoabdominal aortic aneurysms. The Authors also present their current methods used for prevention of ischemic and reperfusion injury.