[Extended aortic bypass operation for dissecting aortic aneurysm of De Bakey type III: experimental and clinical...

For the purpose to achieve good operative results of dissecting aortic aneurysm of De Bakey type III, an extended aortic bypass operation was utilized in our institute. Experimental study: Twenty two mongrel dogs were operated upon by placing bypass graft between the descending aorta distal to the left subclavian artery and the infrarenal abdominal aorta. The descending aorta distal to the proximal anastomosis was divided and closed. Fifteen dogs survived operations. Thrombus formation in the distal descending aorta was noted in all animals, but not extended beyond the level of coeliac artery. In six dogs which survived more than three months after the operation thrombi were well organized. Clinical application: four patients were operated upon using this operative procedure. Three patients survived the operation, but one patient who had previous abdominal reconstruction for ruptured aneurysm developed paraplegia postoperatively and eventually died from prolonged respiratory failure five months after operation. Two patients have been in excellent health until 10 to 26 months after operation and postoperative aortograms showed conspicuous thromboexclusion of the distal descending aorta. It is concluded that extended aortic bypass operation is useful for the surgical treatment of De Bakey type III aortic dissection.