Technical advances in resection and graft replacement of thoracic, abdominal, peripheral aneurysms.

Condition we now term aneurysm, deriving from the Greek word for "a sidening," has been recognized since the earliest days of medical history. The predilection of such lesions to rupture, with resultant hemorrhage, thrombosis, and distal ischemia, has led to constant attempts at surgical management, including ligation and incision, wrapping, wiring, plasticizing, packing, obliterative and reconstructive endoaneurysmorrhaphy, and a wide variety of procedures both ingenious and ingenuous. Modern treatment depends on minimal dissection, to obtain proximal and distal control, incision of only the anterior wall, and every attempt to maintain the integrity of the major portion of the involved vessel. A technique of intrasaccular interpolative anastomosis is used, taking deep and generous. The posterior wall of the aneurysm supports the suture lines and splints the graft firmly. Coverage of the graft with the residual sac protects the surrounding organs, minimizing possible complications. The method is applicable to aneurysms of a variety of anatomic sites, even in the presence of dissection, except those aneurysms involving the transverse aortic arch and thoracoabdominal aneurysms involving major visceral branches. Finally, the described techniques lend themselves easily to any sizable peripheral aneurysm and are simpler and safer than other surgical modalities such as total extirpation and bypass procedures.