© 2003 by BMJ Publishing Group & British Cardiac Society
EDITORIAL
Open surgery for thoracic aortic disease
1 Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, Memorial Hermann Hospital, Houston, Texas, USA
2 Department of General and Vascular Surgery, Guy’s & St Thomas’ Hospital, London, UK
Correspondence to:
Correspondence to:
Mr Peter Taylor, Department of General and Vascular Surgery, Guy’s & St Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH, UK;
taylorvasc@aol.com
While new technologies appear to offer potential advantages over traditional therapies for thoracic aortic disease, open surgery is still the mainstay of treatment for the overwhelming majority of patients
Keywords: thoracic aorta; dissection; aneurysm; stent graft
| The first 150 words of the full text of this article appear below. |
Many recent technical advances have enhanced the safety of open surgery of the descending thoracic aorta. Previous to the refinement of these adjuncts and techniques, surgeons such as Stanley Crawford showed that simple aortic cross-clamping with expeditious surgery produced the best results.1 In Crawford’s era of "clamp and go", time limitations pressured surgeons to perform anastomoses rapidly with perfect haemostasis. The duration of aortic cross-clamping was directly related to survival and to serious complications such as paraplegia and visceral ischaemia. The role of bypass, intercostal reimplantation, and cerebrospinal fluid drainage was unclear, in that none of these techniques appeared to be beneficial.
Cross-clamping the aorta below the left common carotid artery and above the coeliac axis increases proximal systemic pressure, which in turn increases the cerebrospinal fluid pressure. In addition, the mean arterial pressure distal to the clamp will fall, and therefore the distal spinal cord will be at risk
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