[Experimental and clinical studies on the exclusion and bypassing operation for abdominal aortic and iliac artery...

For the purpose of simplifying operative techniques and decreasing operative risks, we evaluated excusion and bypassing operation for infrarenal abdominal aortic and iliac artery aneurysm (AAA) both experimentally and clinically. This method includes dissection and closure of proximal stump of the aneurysm and anatomical bypass technique in principle. In the experiments, the ratio of internal pressure of the excluded aorta (e.Ao) to systemic blood pressure (E.P.I.) was 0.62 +/- 0.03 (n = 7, mean +/- S.D.). The thrombotic occlusion period of the e.Ao was estimated to be about 2 weeks. Clinically, we have carried out exclusion operation in 40 (43.8%) out of 91 cases of AAA since June 1977. In 49% of the cases hypogastric artery aneurysm was present. The excluded aneurysm revealed thrombotic occlusion within 1 month by CT scan and rupture or DIC were seen in none of the cases. There were no operation related mortality and postoperative cumulative survival rate was 94.7% at 1 year, 55.6% at 5 and 9 years. Since this operative technique is highly safe and simple, we consider this exclusion method is valuable not only in high-risk cases of elderly patient as well as in cases with extensive aneurysm of the hypogastric artery but also in many other patients.