DeBAKEy CARDIOvASCuLAR JOuRNAL - Methodist Hospital

Figure 37. Left: Preoperative aortogram of abdominal aneurysm with
involvement of renal and visceral vessels with erosion of the spine.
Right: Post operative aortogram following resection of aneurysm with
reconstruction of renal and visceral artery with Dacron graft
and stablization of the spine.
350
300
250
200
150
100
50
0
Figure 39. AAA only
200
150
100
50
0
177
10
5.3%
1965-1975
Cases 187
93
303
6
1.9%
1976-1985
Cases 309
AAA only = 964
OP survival = 940
OP death = 24 2.4%
12
11.4%
1965-1975
Cases 105
152
10
6.1%
1976-1985
Cases 162
295
5
1.6%
1986-1995
Cases 300
198
6
2.4%
1986-1995
Cases 204
AAA with associated procedures = 569
OP survival = 536
OP death = 33 5.7%
Figure 40. AAA with associated procedures
165
3
1.7%
1996-2005
Cases 168
93
5
5.1%
1996-2005
Cases 98
Figure 38. Top: Aneurysm of abdominal aorta with rupture
into inferior vena cava. Bottom: Post operative study following
resection of aneurysm and repair of inferior vena cava.
Uncomplicated Aneurysm of Ascending Aorta
and Aortic Arch
Simple aneurysms of the ascending aorta or the aortic
arch accounted for 153 patients during this four-decade
period. During the formative phase of operations for
complex aortic disease, the operative mortality peaked
at 15% in the third decade before declining drastically
in the fourth decade after the operation became more
refined and standard (Figure 41).
Ascending aorta and aortic arch aneurysm operations
with associated procedures were more the norm, with
a total of 475 patients receiving surgery with this combination.
Coronary bypass and valve replacement were
the most common associated procedures. In this group
as well as that above, the operative mortality declined
during the fourth decade (Figure 42).
Acute dissection of the ascending aorta and arch
were encountered in 61 patients, and all were operated
on emergently (Figure 43). The operative mortality was
31.1% (Figure 44), with 19 of the 61 patients dying from
rupture or complications of rupture. An example of an
acute ascending aortic dissection and rupture into the
right ventricle is displayed in Figures 45 and 46.
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