Late complications after surgical exclusion of the thoracic aorta

Two patients who under- went surgical exclusion of the tho- racic aorta for chronic dissecting an- eurysms of the descending aorta died 4 and 8 years after surgery due to complications in part related to the operative technique_ One patient de- veloped pseudoaneurysm of the proximal aortic stump with fatal ex- sanguination through an aortapulmo- nary fistula. The other patient devel- oped progressive dilatation of the re- maining abdominal aorta with subse- quent rupture. The surgical approach in this case was extremely difficult because of the previous exclusion procedure which determined a highly demanding reoperation. Although surgical exclusion of the thoracic aortic may be a useful technique in some situations, we must be aware of its early and late complications and, in our opinion, it should be seen only as an alternative treatment for very special patients with diseases of the descending thoracic aorta. (Eur J Cardio-thorac Surg (1996) 10:590-592)