Complex abdominal aortic pathologies: Operative and midterm results after pararenal aortic aneurysm and type IV thoracoabdominal aneurysm repair

The aim of the study was to describe the clinical outcome of pararenal aortic aneurysm (PAAA) and type IV thoracoabdominal aneurysm (TAAA) repair, with special consideration placed on disease-related complications and midterm follow-up. Data were collected retrospectively between 1997 and 2004 for patients with PAAA or type IV TAAA repair. Comorbidities, operative details, and early and late outcome were analyzed to predict disease-related complications. During the study period, 63 patients (33 PAAAs, 30 type IV TAAAs) underwent aortic repair. The 30-day mortality rate of 7.9% was acceptable for complex aortic entities compared with other series. The morbidity for cardiac events was 3.2%, for pulmonary complications 17.5%, and the need for reoperation was 14.3%. With regard to disease-related complications, two patients (3.2%) required dialysis and one patient (1.6%) developed paraplegia (spinal cord ischemia) after type IV TAAA repair. Complex aortic repair for PAAAs and type IV TAAAs showed acceptable perioperative mortality, morbidity, and midterm survival rates. Patients with type IV TAAAs suffered more major complications, such as postoperative dialysis or spinal cord ischemia.