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J.Jpn. Surg. Soc.. 110(5): 249-254, 2009

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Thoracic and Cardiovascular Surgery Division, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan

Yukio Kuniyoshi

Although the operative results of descending aortic aneurysms are better than those of aortic aneurysms in other thoracic aortic sites, there are still problems to be resolved. To prevent postoperative cerebral infarction after aortic clamping in proximal descending aortic aneurysms, the open proximal anastomosis method is recommended. The arch aorta should not be clamped in cases of chronic type III aneurysms because there is a high possibility of aortic dissection due to fragility of the aortic wall. In two-thirds of descending aortic aneurysms, postoperative paraplegia is still a devastating complication. Many methods have been devised to prevent this complication, such as 1) distal perfusion, 2) mild hypothermia, 3) reimplantation of segmental arteries, 4) cerebrospinal fluid drainage, 5) multisegmental aortic clamping, and 6) motor-evoked potential monitoring, and can be utilized in combination.

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