Stenotic and obstructive lesions in acute dissecting thoracic aortic aneurysms

The present study of 33 operatively treated patients, 88 per cent of whom survived the procedure, is concerned with an important problem associated with acute thoracic aortic dissection, the stenotic and obstructive lesions of the aorta and its branches. Their variety and nature are described, as ar...

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Bibliographic Details
Published in:Annals of surgery 1975-05, Vol.181 (5), p.662-669
Main Authors: Shumacker, Jr, H B, Isch, J H, Jolly, W W
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Aged
Aorta - transplantation
Aorta, Thoracic
Aortic Aneurysm - complications
Aortic Aneurysm - mortality
Aortic Aneurysm - surgery
Arterial Occlusive Diseases - etiology
Arterial Occlusive Diseases - mortality
Arterial Occlusive Diseases - surgery
Brain Diseases - etiology
Coronary Vessels - surgery
Female
Humans
Indiana
Ischemia
Leg - blood supply
Male
Methods
Middle Aged
Saphenous Vein - transplantation
Transplantation, Autologous
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Summary:The present study of 33 operatively treated patients, 88 per cent of whom survived the procedure, is concerned with an important problem associated with acute thoracic aortic dissection, the stenotic and obstructive lesions of the aorta and its branches. Their variety and nature are described, as are the additional operative procedures deemed necessary at the time of the operation, immediately thereafter, or later on. Much has been learned about these difficulties from clinical and autopsy observations and especially from careful arteriographic surveys. They seem to be generally well withstood following resectional and grafting procedures upon the affected segment of the thoracic aorta. Occasionally, additional operative manipulations may be necessary at the same time, for example, interpolation of grafts between the ascending aortic graft and a coronary when the origin of the latter is sheared off by the dissection, and distal arterial manipulations when the patient still has ischemic lower extremities immediately after the primary procedure. Later operations must sometimes be performed because of persistence of complaints such as intermittent claudication. It is extremely rare that immediate reoperation is advisable because of indications of intra-abdominal ischemia. Much more can be learned from careful pre- and postoperative arteriographic study.
ISSN:0003-4932
1528-1140
DOI:10.1097/00000658-197505000-00021