Surgical treatment of nondissecting aneurysms of the descending thoracic aorta.

Between 1966 and 1981, 58 patients underwent operation for nondissecting aneurysm of the descending thoracic aorta at the University Central Hospital in Helsinki. The cause of the aneurysm was atherosclerotic in 38 cases. Nine aneurysms were post-traumatic and 11 had developed after correction of aortic coarctation with a Dacron patch. Rupture of the aneurysm with hypotension and haemothorax were present on admission in three patients (5.2%). Six operations were performed without use of shunt or bypass. In the other patients the circulation to the spinal cord and viscera was protected during the aortic resection and reconstruction. Left atrial-to-femoral artery bypass was used in 43 patients, femoral vein-to-femoral artery bypass in five, heparinized TDMAC shunt in three patients and total perfusion in one case. Transient paraparesis and irreversible paraplegia each occurred in one case in which some form of circulatory protection had been used. In the latter patient there was aneurysm rupture and hypotension on admission to hospital, and resection (greater than 10 cm) was done with TDMAC shunt. The patient died postoperatively of pulmonary complications. The total operative mortality was 12.1%. The mortality in the follow-up period (range 1-14 years, mean 5 years) was 13.8%. The conclusion from the study was that, when adequate technique of aneurysm resection is combined with shunt or bypass, an acceptable operative mortality and low incidence of paraplegia are obtainable.