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.