Sacciform Aneurysm Research Articles

Successful resection of aneurysm of distal aortic arch and replacement by graft.

During the past few years, increasing interest has been aroused in excisional therapy for aneurysms of the aorta. In general, two types of procedures have been developed for this purpose, namely, tangential excision with repair of the resultant defect by lateral aortorrhaphy and resection of the involved segment of aorta with restoration of continuity by aortic homograft. 1 While the former procedure may be employed for sacciform aneurysms located in any part of the aorta, including the arch, there are definite limitations to application of the latter procedure in this respect owing to the potential ischemic effect of temporary arrest of the circulation from cross clamping of the aorta during its performance. Obviously, the more proximal the lesion, the greater is the likelihood of ischemic damage to vital organs from this procedure. Accordingly, this problem assumes particular importance for lesions located about the aortic arch and has, therefore, seriously limited the

Retrograde Abdominal Aortography

Plain x-ray examination of the abdominal aorta and iliac arteries offers information only in the presence of calcification of the arterial walls or calcified aneurysms. Retrograde abdominal aortography is a simple method for the study of all the pathological changes of the aorta and iliac arteries. This method consists in exposure of the femoral artery by blunt dissection under local anesthesia at the level of Scarpa's triangle and its puncture with a trocar 1.5 mm. in diameter, through which are injected 50 c.c. of a 70 per cent solution of diodrast in two and a half to three seconds. A tourniquet is applied at the root of each lower extremity in order to prevent the passage of the contrast medium into their arteries. The Trendelenburg position may be required in certain cases. To avoid changes in pressure when the opaque substance is injected by hand, the author has designed an apparatus that maintains a constant pressure and rate of injection. It consists of a pump with a piston which acts upon the plunger of the syringe. The piston is worked by an air compressor with a regulator and manometer. With a trocar 1.5 mm. in diameter and a constant pressure of 15 pounds, it is possible to inject 25 c.c. of the opaque substance per second, the speed of injection being modified according to the blood pressure and vascular condition of the patient. The first film is taken when 40 c.c. of the opaque substance have been injected and a second one immediately afterwards, using a fast film changer. When the injection is complete, the trocar is withdrawn, a suture is placed in the adventitia of the artery, and the wound is closed. The patient should recieve a pheno-barbital the night before and morphine hypodermically one hour prior to the injection, in order to obtain relaxation and avoid pain. Among the inflammatory lesions of the abdominal aorta and iliac arteries, syphilitic arteritis occupies first place because of its frequent occurrence. It may produce dilatation or obliteration of the arteries. In dilatation the muscular and elastic coats of the artery are destroyed, leading to the formation of the different types of aneurysm. As examples we have the following histories: S. B., white, 52 years old, married, had untreated syphilis; the Kahn and Meinicke tests were markedly positive. The abdominal aorta was palpable, and there was a systolic murmur. Arteriography shows uniform dilatation of the abdominal aorta with a small sacciform aneurysm at the end of the left common iliac (Fig. 1). R. G., 30 years old, gave a history of slight epigastric pains for six months' with no relation to meals; then, sudden epigastric pain of increasing intensity, with radiation toward both lower extremities. The Kahn and Meinicke tests were strongly positive. Palpation revealed a pulsating epigastric tumor the size of a grapefruit. The clinical impression was a tumor of the head of the pancreas.

Aneurysm of the aorta

The differential diagnosis of sacciform aneurysm and cylindrical dilatation is quite easily made, as in the sacciform, a pulsating definite sac is seen. Clotting and organization within a sac frequently occurs, with resultant loss of pulsation. Pulsation of a group of glands, by pressure transmitted from the aorta, should be differentiated. In cases in which there is cylindrical dilatation the thoracic aorta can be seen throughout its entire course. The author has never been able to recognize an aneurysm below the diaphragm, and the presence of calcified plaques cannot be depended on for such a diagnosis.

A case of sacciform aneurysm of the descending aorta, projecting into and occluding the left bronchus; destructive tuberculosis of the left lung; autopsy

A case of sacciform aneurysm of the descending aorta, projecting into and occluding the left bronchus; destructive tuberculosis of the left lung; autopsy