Outcome of Open Repair of Thoracoabdominal Aortic Aneurysm in Takayasu Arteritis: A Retrospective Analysis.

BACKGROUND: Takayasu Arteritis (TA) is an immune mediated arteritis causing inflammation of the aorta and its branches, which can result in aortic aneurysms. Our aim is to describe the outcome of surgical management in these patients who presented with Thoracoabdominal aortic aneurysm (TAAA). METHODS: Between 2003 and 2023, 40 TA patients with TAAA underwent operative repair. RESULTS: There were 24 females and 16 males, in the age group of 19-53 years, with hypertension in 20 patients. Raised Erythrocyte sedimentation Rate was present in 13 patients. According to Crawford classification, there were 2 patients with type I, 2 with type II, 17 with type III, 12 patients with type IV and 7 with type V aneurysm. Multiple steno-occlusive lesions of aortic branches were present in 21 patients, with majority affecting the renal artery. Femoral Artery Femoral Vein Partial cardiopulmonary bypass was used for types I, II, III and V. Separate bypass to visceral branches was done in eight patients, of whom five had multiple bypasses and three patients only had renal bypass. Twelve patients underwent reimplantation of branches, out of which nine had multiple vessel reimplantation. Four patients underwent staged repair of the aneurysm, which included visceral debranching in the first day, followed by repair of the aneurysm in the next day. In the immediate postoperative period, ten patients developed acute kidney injury and two required dialysis. Other morbidities included acute respiratory distress syndrome (ARDS), spinal cord dysfunction, bleeding, and wound complications. Three patients expired in the immediate postoperative period. Mean duration of intensive care unit stay was 4.1 days and hospital stay was 12.7 days. Comparison of disease activity with morbidity and mortality was statistically insignificant. Patients were on follow-up for a range of 6 months to 14 years and median follow-up of 25 months. Over this time period four patients expired and four developed anastomotic pseudoaneurysm requiring intervention. On comparing the disease activity at the time of surgery with the long-term arteritis related complications that required intervention, the P value was 0.653 and hence statistically not significant. The 10-year survival rate is 84.4%. CONCLUSIONS: Surgical repair has good and satisfactory outcome, with low early and late mortality rates. Progression of disease can occur at any stage of the disease, hence indicating the need for long term follow-up and frequent imaging.

Muscle flaps in pulmonary infections: a case series from Northeast India.

AIM: Treatment of complications due to pulmonary infections usually involves lung resection with or without debridement. Managing residual intrathoracic defects, chronic empyema, and bronchopleural fistulae after such resections poses unique challenges. METHODS: We retrospectively reviewed the data of all 9 patients referred to us with complications due to pulmonary infections, including the surgical procedures, flaps used, and their outcomes between 2018 and 2019. RESULTS: The mean age of the patients was 30 years (range 9?48 years). The primary disease was tuberculosis in 6 (66%) patients. Complications of primary infections were pneumothorax (n = 3), auto-pneumonectomy (n = 2), organized empyema (n = 3), and recurrent hemoptysis (n = 1). Initial interventions included lobectomy (n = 2), tracheoesophageal repair (n = 1), bronchial artery embolization (n = 1), intercostal tube drainage (n = 4), and decortication(n = 1). Complications after primary interventions included bronchopleural fistula (n = 4, 45%), recurrent empyema (n = 3, 33%), tracheal stump dehiscence (n = 1, 11%) and non-resolving hemoptysis (n = 1, 11%). Pathological microorganisms were isolated in 8 (88%) patients. Secondary corrective surgical interventions along with pedicled muscle flap interposition and reinforcement were undertaken. Nine flap procedures with or without thoracoplasty were performed. There was no open thoracostomy conversion. There was one death postoperatively. CONCLUSION: A locoregional pedicled flap with or without thoracoplasty is an effective option to manage complications of pulmonary infections. The cardiothoracic surgeon should have a knowledge of the locoregional flaps of the thorax and abdomen to address such complications.