ANEURYSM OF THE DESCENDING THORACIC AORTA - REPLACEMENT WITH THE USE OF A SHUNT OR BYPASS

Abstract

The optimal method of protecting the spinal cord and viscera during resection of aneurysms of the descending thoracic aorta is controversial, and some surgeons recently abandoned shunting and bypass techniques. This may not be the safest approach; experience is reviewed with a consecutive series of these aneurysms, all of which were done with bypass or a shunt. Between 1965-1976, 23 aneurysm replacements were performed with femorofemoral bypass. From 1976-1980, the Gott shunt was used in 12 aneurysm operations. Atherosclerotic, traumatic and dissecting aneurysms were all represented. Operations (19) 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 yr survival rate (including operative deaths) is 79%. 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.