Aortic aneurysm operations: Past, present, and future

Effective methods to treat aortic aneurysms are now available, although the se lesions still challenge the cardiovascular surgeon. Attempts at treatmen t began in earnest in the 1800s, with the introduction of indirect and dire ct methods of repair. A major breakthrough occurred in the late 1800s, when Dr Rudolph Matas devised a method for internal repair of aneurysms in whic h continuity of blood flow was restored by excising the diseased portion of the lesion and creating a tunnel through the remaining normal portion. Mat as named this technique reconstructive endoaneurysmorrhaphy. Until that tim e, surgeons had treated aneurysms by ligating the parent vessel with a Hunt erian ligature or introducing foreign material to promote coagulation. Liga ting the aneurysm rendered the extremities vulnerable to ischemic damage, h owever, and results were unpredictable with the use of various foreign mate rials. Around the turn of the century, Carrel began experimenting with diff erent techniques for vascular anastomoses. The work of these early pioneers formed the basis for much of the modern treatment of aneurysms of the thor acic aorta. My experience began in 1950, when I excised a large aortic aneurysm in one of Dr Alfred Blalock's patients. The patient survived and was cured. After that experience, I knew that aortic aneurysms could be treated successfully by aggressive surgical means. Treatment has changed, however, from the ear ly emphasis on excising the lesion to the present practice of restoring cir culatory continuity with a suitable graft, ie, endoaneurysmorrhaphy. The de velopment of reliable synthetic grafts has been one of the most important a dvances in the treatment of aneurysms. The surgical technique used today de pends on the anatomic location of the aneurysm, which can occur anywhere fr om the aortic annulus and aortic valve to the distal thoracic aorta and vis ceral vessels in the abdomen. (C) 1999 by The Society of Thoracic Surgeons.