Aneurysms of the descending aorta. Surgical experience in 48 patients

Uniformity of opinion does not exist concerning an optimal surgical strategy for descending aortic aneurysms. In order to assess the impact of surgical technique on operative mortality, morbidity, late outcome, we reviewed 48 consecutive patients operated upon from 1976 to 1980. Average age was 61 years, and 37 patients (77%) were men. The average interval of aortic occlusion in the Gott shunt group was 48 minutes, which was significantly longer than that of patients operated upon without shunts (30 minutes). No patient in the Gott shunt group had postoperative paraplegia, but it was noted in two patients (18%) treated without a shunt. Operative deaths in patients with Gott shunts were caused by cardiac (two patients), neurologic (one patient), pulmonary (one patient), and abdominal (two patients) factors. A pulmonary embolus caused the single postoperative death in the "no shunt" group, and another patient died intraoperatively. A group of seven patients were treated by temporary femoral vein--femoral artery bypass because of extensive aneurysmal disease, advanced associated major systemic disorders, or anticipated excessive hemorrhage when the aneurysm was opened. All patients survived free of neurologic sequela, but one developed a reversible intraoperative coagulopathy. This study underscores the safety and usefulness of the femoral vein--femoral artery bypass in treating certain descending thoracic aneurysms and reinforces the importance of several technical guidelines concerning the proper insertion and use of the Gott shunt. These guidelines would have significantly reduced the observed operative morbidity and mortality.