Diagnostic and surgical considerations in the treatment of thoracoabdominal and suprarenal aortic aneurysms.

Thoracoabdominal and suprarenal aortic aneurysms may occur more frequently than originally thought. A review of our operative experience with aortic aneurysm during a 4 1/2 year period disclosed 17 (8 percent) aneurysms of the thoracoabdominal and suprarenal aorta. Acute rupture in five patients (29 percent) emphasizes the possible need for urgent treatment precluding transfer to a major university referral center. Nine patients (53 percent) had previously been operated on for aortic aneurysm, illustrating the systemic nature of aortic aneurysm disease and the need for lifelong follow-up. All patients survived, but paraplegia resulted in 2 patients (12 percent) with ruptured aneurysms. Pulmonary insufficiency was the major cause of postoperative morbidity. The high incidence of paraplegia reported for extensive chronic dissecting aneurysms has influenced our decision to postpone resection and carefully follow three additional patients with such lesions.