Treatment of aneurysms of the aortic arch. A progress report

Graft replacement therapy was employed in the treatment of 67 patients with aneurysms of the transverse aortic arch. Patients were divided into three groups according to the extent of the aneurysm, which determined method of treatment and results. Group I consisted of 37 patients with distal aneurysms treated by simple proximal and distal clamping and aortic reconstruction, with survival in 36. Similarly located lesions in three patients in Group II, in whom the aorta could not be clamped proximally, were treated by hypothermia and circulatory arrest without graft inclusion technique, with survival in one. In Group III, the 27 patients, three with recurrent lesions and 19 with extensive aneurysms including the entire aorta in four, were treated by hypothermia, brachiocephalic arterial clamping, graft inclusion, and direct brachiocephalic vessel reattachment. The distal aneurysmal disease was replaced in most cases by a staged operation including total aortic replacement in two patients. Of the 27 patients in this group, 26 survived both the arch and subsequent operations.