TY - CHAP M1 - Book, Section TI - Thoracoabdominal Aneurysms A1 - Lum, Ying Wei A1 - Roseborough, Glenn S. A2 - Yuh, David D. A2 - Vricella, Luca A. A2 - Yang, Stephen C. A2 - Doty, John R. PY - 2014 T2 - Johns Hopkins Textbook of Cardiothoracic Surgery AB - EpidemiologyThoracoabdominal aneurysms (TAAs) develop in patients with atherosclerotic disease, chronic aortic dissection, and connective tissue disorders (e.g., Marfan syndrome, Ehler–Danlos syndrome).PathophysiologyPathologic processes include chronic inflammation, remodeling of extracellular matrix, and depletion of vascular smooth muscle cells. Elastin depletion in the media layer of the aortic wall is a common finding.Clinical featuresApproximately 80 percent of TAAs are atherosclerotic in nature, associated with smoking, hypertension, hypercholesterolemia, and advanced age. Approximately 20 percent of TAAs develop from chronic aortic dissections and occur in patients with connective tissue disorders. The risk of rupture increases rapidly when aneurysmal diameter reaches or exceeds 6 cm. The most common presentation includes abdominal or back pain, although many TAAs are also discovered incidentally.DiagnosticsTAAs are classified commonly according to the anatomic scheme developed by Crawford (types I through V). Helical computed tomography and magnetic resonance angiography are the diagnostic modalities of choice, largely having supplanted angiography.TreatmentMedical therapy includes the reduction of risk factors for aneurysmal expansion (e.g., smoking, hypercholesterolemia) and tight blood pressure control predicated on the use of β-blockers.Interventional therapy includes open surgical, hybrid and totally endovascular repair. Spinal cord protection is of particular concern in all methods of repair.OutcomesIn-hospital mortality rates after surgery range between 8 and 15 percent in most series. Common postoperative complications include bleeding, respiratory failure, myocardial infarction or cardiac failure, renal failure, and paraplegia. Operative risk increases with advanced age, aneurysm complexity, emergency operation, coronary and cerebrovascular disease, pulmonary disease, and renal failure. Outcomes may be improved with the distal perfusion approach to repair. Five-year survival rates range between 53 and 73 percent. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesssurgery.mhmedical.com/content.aspx?aid=1104591343 ER -