Aneurysms of the aorta a consideration of pre- and postoperative medical management

Abstract

The mortality following excision of aneurysms of the thoracic and abdominal aorta has been acceptably low and forms a sharp contrast with the mortality figures of unoperated series. Over 2,500 aneurysms of various types have been resected by the surgical group at the Baylor University College of Medicine. The mortality rate for resection of abdominal aneurysms is about 9 per cent over-all, a figure which includes those with and without associated heart disease and also includes those which had ruptured at the time of admission. The mortality rate for descending thoracic aneurysms is 20 per cent and that for all thoracic aneurysms about 26 per cent. A 5 year survival figure of patients after abdominal aneurysmectomy was 58 per cent contrasted with 9 per cent in the nonoperated series of Estes and Wright. An analysis of 179 patients with dissecting aneurysms disclosed an operative mortality of 21 per cent. When the dissection began beyond the origin of the left subclavian, the operative mortality among the 94 patients operated upon in the past 5 years was only 12 per cent. Despite the high incidence of hypertensive disease, ischemic heart disease and associated cardiorenal abnormalities, most patients can be carried safely through surgery. There are virtually no late complications which are unique to this group of patients. In order that the operative and postoperative course may be smooth as possible, careful attention must be given to the possible presence of any abnormality of cerebrovascular, cardiopulmonary, renal and hepatic function. Associated disease such as occlusive disease of arteries supplying the lower extremities, hiatal hernia, cholelithiasis should be searched for in order that they may be corrected at the time of the aneurysmectomy if the operative approach permits. The cardiologist or internist plays a vital role in preoperative work-up as well as the operative and postoperative periods and it is of fundamental importance that he understand the problems related to each of these phases.