Late rupture after dacron wrapping of aortic aneurysms

We reviewed the entire experience in Hawaii with external wall reinforcement with Dacron graft material as a primary method of surgical treatment of aortic aneurysm. Over the past 11.5 years, 14 such procedures have been performed. Two of the aneurysms were located in the distal aortic arch, eight in the descending thoracic aorta, and four in the abdominal aorta. The operation was done in each instance as a safer alternative to resection and replacement in high-risk patients. There were two postoperative deaths, one unrelated to the surgery. To date, three of the 12 surviving patients have experienced aortic rupture at the graft site, 6 months to 3 years later. Two died of exsanguinating hemorrhage and a third survived corrective surgery. The rupture in each instance occurred through the entire wrap itself. Two of these developed aortobronchial fistulas and one an aortoesophageal fistula. The high incidence of late rupture of wrapped aneurysms, as reported here, has not been documented in the literature and raises serious questions as to the efficacy of this procedure.