Shunt graft with resection for aneurysm of arch of aorta.

Abstract

As our experience with resection and replacement with homologous graft of the abdominal aorta has increased, we have turned our attention to the possibility of the management of aneurysms at higher levels, such as the arch and the descending thoracic aorta. There is one important difference, however, that makes resections of the arch and thoracic aorta hazardous. This is the fact that, with the exception of coarctation, with its massive collateral circulation, it is not possible to shut off the thoracic aorta for a period of time necessary to resect a complicated aneurysm and insert a graft without irrevocable damage to the spinal cord. Aneurysmorrhaphy or plastic sacculectomy, maintaining a functional channel through the aorta during these procedures, has been accomplished in some cases, but in many of these it is fraught with great danger except in the smaller, readily mobilized saccular type. There is the constant danger, during the