Spinal Protection with Veno-Arterial By-Pass for Surgery of Thoracic Aorta : 26-Year Experience

Authors report their experience with surgical treatment of descending thoracic aortic aneurysms using femoro-femoral by-pass for spinal protection. Between June 1976 and December 2001, 650 patients with thoracic aortic aneurysm were seen and in 170 of them the descending thoracic aorta was involved. Surgery was needed in 73 patients, among whom 34 had fusiform chronic aneurysm of thoracic aorta, with involvement of proximal abdominal aorta in 12 cases, and 27 had type B aortic dissection. Emergency surgical treatment was needed in 38 patients. Resection of the diseased aorta was performed in 71 patients, patch repair of the intimal tear in 2. Spinal protection was achieved with femoro-femoral by-pass in all cases. Nineteen cases (26.02%) of post-operative death were observed. There were four cases of lower limbs motor deficit reported, two in thoraco-abdominal aortic aneurysms, and two in patients with type B aortic dissection. Clinical experience shows that veno-arterial by-pass achieves low incidence of post-operative paraplegia.