Stroke in surgery of the arteriosclerotic descending thoracic aortic aneurysms: influence of cross-clamping technique of the aorta

Kawaharada, Nobuyoshi; Morishita, Kiyofumi; Fukada, Johji; Hachiro, Yoshikazu; Fujisawa, Yasuaki; Saito, Tatsuya; Kurimoto, Yoshihiko; Abe, Tomio
April 2005
European Journal of Cardio-Thoracic Surgery;Apr2005, Vol. 27 Issue 4, p622
Academic Journal
Abstract: Objective: The risk of stroke caused by dislodgment of loose atheromatous plaque or mural emboli is increased by cross-clamping of the aorta. Some patients undergo descending thoracic aortic aneurysm repair with proximal aortic cross-clamping between the left common carotid artery and the left subclavian artery. The objective of this study was to determine the influence of proximal aortic cross-clamping in arteriosclerotic aneurysm or dissecting aneurysm repair. Methods: Between May 1984 and May 2003, 81 patients underwent elective surgery for distal arch or descending aortic aneurysm repair with proximal aortic cross-clamping between the left common carotid artery and the left subclavian artery. To evaluate the influence of the proximal aortic cross-clamping, patients were divided into two groups: patients who had undergone arteriosclerotic aneurysm repair (group I, n=25) and patients who had undergone dissecting aneurysm repair (group II, n=56). Results: Eight (9.9%) of the 81 patients had a stroke. Six strokes occurred in operations for arteriosclerotic aneurysm repair group I and two strokes occurred in operations for dissecting aneurysm repair group II (24 vs 3.6%; p=0.009). In-hospital mortality rates were 12% in group I and 8.9% in group II (p=0.70). Major postoperative complications included renal failure requiring hemodialysis (in 4.2% of the patients in group I and in 8.3% of the patients in group II, p=0.99) and pulmonary complication (in 20% of the patients in group I and in 16% of the patients in group II, p=0.67). Conclusion: Cross-clamping between head vessels should be avoided if at all possible when operating on patients who have arteriosclerotic descending thoracic aneurysms.


Related Articles

  • Aneurysms of the abdominal aorta: a 20-year study. Bowers, Dorrance; Cave, William S. // Journal of the Royal Society of Medicine;Oct1985, Vol. 78 Issue 10, p812 

    One hundred and eighty-eight patients in whom the diagnosis of aneurysm of the abdominal aorta (AAA) was established after 1 January 1960 were followed until their deaths or to 31 December 1979. By the actuarial method, the cumulative 5-year risk of an intact aneurysm progressing to rupture was...

  • SPONTANEOUS RUPTURE OF THE THORACIC AORTA THROUGH AN ATHEROMATOUS PLAQUE. Rodriguez, Héctor F.; Rivera, Edwin // Annals of Internal Medicine;Feb61, Vol. 54 Issue 2, p307 

    Discusses the case of a female patient with spontaneous rupture of the aorta in its thoracic portion through an atheromatous plaque. Patient medical history; Signs and symptoms; Diagnosis; Patient death due to severe hemoptysis.

  • Abdominal aortic aneurysms. Hopkins, N.F. Gowland // British Medical Journal (Clinical Research Edition);3/28/1987, Vol. 294 Issue 6575, p790 

    Focuses on various ways in treating abdominal aortic aneurysms in Great Britain. List of diagnostic technique in detecting aneurysms; Process of elective surgery; Significance of clinical examination before operation.

  • Enhanced Recovery after Elective Open Surgical Repair of Abdominal Aortic Aneurysm: A Complementary Overview through a Pooled Analysis of Proportions from Case Series Studies. Gurgel, Sanderland J. T.; El Dib, Regina; do Nascimento Jr, Paulo // PLoS ONE;Jun2014, Vol. 9 Issue 6, p1 

    Objectives: To evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) programs in elective open surgical repair (OSR) of abdominal aortic aneurysm (AAA). Background: Open surgical repair of AAA is associated with high morbidity and mortality, prolonged hospital stay and high...

  • Abdominal aortic aneurysm surgery for octogenarians. Hiroyuki Ishibashi; Takashi Ohta; Ikuo Sugimoto; Hirohide Iwata; Jun Kawanishi; Tetsuya Yamada; Masao Tadakoshi; Noriyuki Hida // Surgery Today;Nov2008, Vol. 38 Issue 11, p1004 

    Abstract Purpose  To define the indications for abdominal aortic aneurysm (AAA) surgery in octogenarians. Methods  We reviewed septuagenarians and octogenarians with a nonspecific AAA diagnosed at our hospital between January, 1990 and June, 2006. Results  Among a total...

  • 848 Relationship between atherosclerotic changes of the carotid arteries and the thoracic aorta in patients with ischaemic insult — which patients require a TEE? Handke, M.; Harloff, A.; Hetzel, A.; Geibel, A. // European Journal of Echocardiography;2003, Vol. 4 Issue suppl_1, pS104 

    An abstract of the article "Relationship between atherosclerotic changes of the carotid arteries and the thoracic aorta in patients with ischaemic insult - which patients require a TEE?" by M. Handke, A. Harloff, A. Hetzel, and A. Geibel is presented.

  • Leukotriene B4 Levels in Human Atherosclerotic Plaques and Abdominal Aortic Aneurysms. van den Borne, Pleunie; van der Laan, Sander W.; Bovens, Sandra M.; Koole, Dave; Kowala, Mark C.; Michael, Laura F.; Schoneveld, Arjan H.; van de Weg, Sander M.; Velema, Evelyn; de Vries, Jean-Paul; de Borst, Gert J.; Moll, Frans L.; de Kleijn, Dominique P. V.; Quax, Paul H. A.; Hoefer, Imo E.; Pasterkamp, Gerard // PLoS ONE;Jan2014, Vol. 9 Issue 1, p1 

    Background: Leukotriene B4 (LTB4) has been associated with the initiation and progression of atherosclerosis and abdominal aortic aneurysm (AAA) formation. However, associations of LTB4 levels with tissue characteristics and adverse clinical outcome of advanced atherosclerosis and AAA are...

  • Embolic Stroke Secondary to an Aortic Arch Tumor. Urrutia, Victor // Angiology;Nov2000, Vol. 51 Issue 11, p959 

    Presents a case report on embolic stroke secondary to an aortic arch tumor. Differentiation of aortic tumors from atherosclerotic plaque; Use of magnetic resonance in the diagnosis; Presentation of literature reviews on aortic masses.

  • High-Grade Atherosclerosis of the Aorta. Siddiqui, Mumtaz A.; Holmberg, Mark J.; Khan, Ijaz A. // Texas Heart Institute Journal;2002, Vol. 29 Issue 1, p60 

    Presents cases of aortic atherosclerosis. Information on aortic atheromas; Procedure for the evaluation and diagnosis of aortic atherosclerosis; Risk of the development of thromboemboli.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics