Aneurysm of the descending thoracic aorta: replacement with the use of a shunt or bypass.

The optimal method of protecting the spinal cord and viscera during the resection of aneurysms of the descending thoracic aorta is controversial, and some surgeons have recently abandoned shunting and bypass techniques. We are concerned that this may not be the safest approach in most surgeon's hands and have reviewed our experience with a consecutive series of these aneurysms, all of which were done with either bypass or a shunt. Between 1965 and 1976, we performed 23 aneurysm replacements with femorofemoral bypass. From 1976 to 1980, we used the Gott shunt in 12 aneurysm operations. Atherosclerotic, traumatic, and dissecting aneurysms were all presented. Nineteen operations were elective and 16 were urgent. Three patients died in the hospital, for an 8.6% operative mortality. There were no cases of paraplegia in the entire series of 35 operations. The actuarial 5 year survival rate (including operative deaths) is 79%. We conclude that when the appropriate surgical technique of aneurysm replacement is combined with a shunt or bypass, an acceptable operative mortality and a very low incidence of paraplegia can be obtained.