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Hong et al. Vessel Plus 2022;6:4 Vessel Plus
DOI: 10.20517/2574-1209.2021.88

Perspective Open Access

Open repair for thoracoabdominal aortic aneurysms

precipitated by chronic aortic dissection

Jonathan C. Hong 1,2,3 , Joseph S. Coselli 1,2,3
1
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030,
USA.
2
Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX 77030, USA.
3
Department of Cardiovascular Surgery, CHI St. Luke’s-Baylor St. Luke’s Medical Center, Houston, TX 77030, USA.
Correspondence to: Dr. Joseph S. Coselli, Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, One
Baylor Plaza, BCM 390, Houston, TX 77030, USA. E-mail: jcoselli@bcm.edu
How to cite this article: Hong JC, Coselli JS. Open repair for thoracoabdominal aortic aneurysms precipitated by chronic aortic
dissection. Vessel Plus 2022;6:4. https://dx.doi.org/10.20517/2574-1209.2021.88

Received: 17 Jun 2021 First Decision: 14 Jul 2021 Revised: 20 Jul 2021 Accepted: 30 Jul 2021 Published: 6 Jan 2022
Academic Editors: Christopher Lau, Alexander D. Verin Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
Chronic dissection of the thoracoabdominal aorta may require surgical repair for aneurysm, malperfusion, or
rupture. Endovascular repair is made difficult by a noncompliant dissection septum, visceral vessels arising from
different lumens, and the common use of diseased aortic landing zones. Thus, open repair remains the gold
standard in terms of favorable outcomes and durability. During thoracoabdominal aortic repair, we use a
multimodal strategy to prevent spinal cord and visceral or renal artery ischemia; key modalities include
cerebrospinal fluid drainage, left heart bypass with and without visceral protection, cold renal protection, and
aggressive reimplantation of intercostal or lumbar arteries. Patients with chronic dissection require lifelong
surveillance, as there is a significant risk for subsequent intervention on unrepaired aortic segments.

Keywords: Thoracoabdominal aorta, open surgery, chronic aortic dissection, type B aortic dissection, aortic
aneurysm

INTRODUCTION
Aortic dissection begins as a tear in the intima that leads to a separation of the layers of the media and the
propagation of blood along a false lumen. Acute aortic dissection of the thoracoabdominal aorta is a
complex condition that can be further complicated by rupture and organ malperfusion. After three months,

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