Michael JacobsNo disclosures

Reduced morbidity and mortality

after staged open repair TAAA repair

Michael Jacobs

Arguments for staged procedures,in addition to collateral development

• “single cavity” operation much less traumatic

• Less blood loss, less transfusion

• Less inflammatory responses

• Less renal failure

• Adds up to lower risk of spinal cord injury

TAAA II single procedures versus staged descending and III-IV repair

15% paraplegia versus none

electrical stimulation

500 V; ~1.2 A, 5 serial stimuli

MEP response

abd. poll. brevis muscle

MEP response

tibialis anterior muscle

pyramidal tract

peripheral nerve

alpha motor neuron in

anterior horn of spinal cord

pyramidal cell

in motor cortex

Open repair TAAA Type II and III

• Staged, if technical feasible

• Most threatening part first

• Large diameter graft

• Interval 4 weeks

• Potential danger: rupture of aneurysm

Michael JacobsNo disclosures