Saccular aortic aneurysms

Most vascular surgeons believe that saccular aortic aneurysms have a more o minous natural history than the typical fusiform aneurysm, although this is not documented in the literature. Expeditious repair is indicated for symp tomatic saccular aneurysms, and intervention is usually advocated even when they are asymptomatic because of the general belief that their unique shap e predisposes them to rupture. The objective of this report is to review th e presentation and surgical management of this uncommon pathology. The reco rds of 10 patients who underwent surgical intervention for an aortic saccul ar aneurysm between 1985 and 1998 were reviewed. To summarize their present ation and management, we grouped patients according to anatomic location: g roup A (distal arch), group B (descending thoracic aorta), group C (viscera l aorta), and group D (infrarenal aorta). From analysis of these data we co nclude that although saccular aortic aneurysms are rare, when present, they are most commonly found in the thoracic and supra-renal aorta. Most cases treated with surgery are symptomatic. Most thoracic and suprarenal saccular aneurysms can be repaired with a patch graft, which spares thoracic interc ostals. Repair of saccular aneurysms of the distal arch are only feasible w hen performed with the use of hypothermic circulatory arrest. Infrarenal sa ccular aneurysms generally require tube graft replacement because the coexi stent atherosclerosis makes patch repair difficult. Endovascular techniques may be the procedure of choice in the future.