Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1988 Sep;208(3):254–273. doi: 10.1097/00000658-198809000-00002

Aortic dissection and dissecting aortic aneurysms.

E S Crawford 1, L G Svensson 1, J S Coselli 1, H J Safi 1, K R Hess 1
PMCID: PMC1493682  PMID: 3421752

Abstract

Operation was employed in the treatment of 546 patients for complications of aortic dissection during the 32-year period of 1956-1988. Current concepts and operative techniques evolved during this period. Fortunately, about half the patients were treated during the latter 4 years, as modern therapy became standardized. The cumulative survival rate was 86% for all patients and 94% for those treated during recent years. Pathologic processes and requirements of operation became clearer by treating 174 patients who had had 198 previous operations by the time of referral. Reoperation was required for complications of operations now considered outdated, heart operations in patients with ascending aortic dilatation, and progressive dilatation of residual segments of the aorta. The 546 patients were followed, and a total of 838 operations were finally employed, resulting in total aortic replacement in 18, near total replacement in 41, entire thoracic aorta in 22, near total thoracic aorta in 33, and the entire thoracoabdominal aorta in 148 patients. Long-term survival in 439 patients after final operation was 66% and 44% at 5 and 10 years, respectively, despite the fact that the median age at first admission was 59. Operative treatment appears to be well-established for this disease.

Full text

PDF
255

Images in this article

266Figs. 12A-C.
on p.266
266Figs. 12A-C.
on p.266
256Figs. 1A and B.
on p.256
257Figs. 2A and B.
on p.257
257Fig. 3.
on p.257
258Figs. 4A-D.
on p.258
259Figs. 5A-C.
on p.259
259Figs. 5A-C.
on p.259
260Figs. 6A and B.
on p.260
260Figs. 7A and B.
on p.260
261Figs. 8A and B.
on p.261
264Figs. 9A and B.
on p.264
265Figs. 10A and B.,Figs. 11A and B.
on p.265

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anagnostopoulos C. E., Prabhakar M. J., Kittle C. F. Aortic dissections and dissecting aneurysms. Am J Cardiol. 1972 Aug;30(3):263–273. doi: 10.1016/0002-9149(72)90070-7. [DOI] [PubMed] [Google Scholar]
  2. BAHNSON H. T., SPENCER F. C. Excision of aneurysm of the ascending aorta with prosthetic replacement during cardiopulmonary bypass. Ann Surg. 1960 Jun;151:879–890. doi: 10.1097/00000658-196006000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bickerstaff L. K., Pairolero P. C., Hollier L. H., Melton L. J., Van Peenen H. J., Cherry K. J., Joyce J. W., Lie J. T. Thoracic aortic aneurysms: a population-based study. Surgery. 1982 Dec;92(6):1103–1108. [PubMed] [Google Scholar]
  4. Cabrol C., Pavie A., Mesnildrey P., Gandjbakhch I., Laughlin L., Bors V., Corcos T. Long-term results with total replacement of the ascending aorta and reimplantation of the coronary arteries. J Thorac Cardiovasc Surg. 1986 Jan;91(1):17–25. [PubMed] [Google Scholar]
  5. Cooley D. A., Livesay J. J. Technique of "open" distal anastomosis for ascending and transverse arch resection. Cardiovasc Dis. 1981 Sep;8(3):421–426. [PMC free article] [PubMed] [Google Scholar]
  6. Crawford E. S., Coselli J. S., Safi H. J. Partial cardiopulmonary bypass, hypothermic circulatory arrest, and posterolateral exposure for thoracic aortic aneurysm operation. J Thorac Cardiovasc Surg. 1987 Dec;94(6):824–827. [PubMed] [Google Scholar]
  7. Crawford E. S., Crawford J. L., Safi H. J., Coselli J. S. Redo operations for recurrent aneurysmal disease of the ascending aorta and transverse aortic arch. Ann Thorac Surg. 1985 Nov;40(5):439–455. doi: 10.1016/s0003-4975(10)60099-9. [DOI] [PubMed] [Google Scholar]
  8. Crawford E. S., Crawford J. L., Stowe C. L., Safi H. J. Total aortic replacement for chronic aortic dissection occurring in patients with and without Marfan's syndrome. Ann Surg. 1984 Mar;199(3):358–362. doi: 10.1097/00000658-198403000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Crawford E. S., DeNatale R. W. Thoracoabdominal aortic aneurysm: observations regarding the natural course of the disease. J Vasc Surg. 1986 Apr;3(4):578–582. doi: 10.1067/mva.1986.avs0030578. [DOI] [PubMed] [Google Scholar]
  10. Crawford E. S., Mizrahi E. M., Hess K. R., Coselli J. S., Safi H. J., Patel V. M. The impact of distal aortic perfusion and somatosensory evoked potential monitoring on prevention of paraplegia after aortic aneurysm operation. J Thorac Cardiovasc Surg. 1988 Mar;95(3):357–367. [PubMed] [Google Scholar]
  11. Crawford E. S., Stowe C. L., Crawford J. L., Titus J. L., Weilbaecher D. G. Aortic arch aneurysm. A sentinel of extensive aortic disease requiring subtotal and total aortic replacement. Ann Surg. 1984 Jun;199(6):742–752. doi: 10.1097/00000658-198406000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Crawford E. S. Thoraco-abdominal and abdominal aortic aneurysms involving renal, superior mesenteric, celiac arteries. Ann Surg. 1974 May;179(5):763–772. doi: 10.1097/00000658-197405000-00032. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Crawford E. S., Walker H. S., 3rd, Saleh S. A., Normann N. A. Graft replacement of aneurysm in descending thoracic aorta: results without bypass or shunting. Surgery. 1981 Jan;89(1):73–85. [PubMed] [Google Scholar]
  14. DE BAKEY M. E., COOLEY D. A., CREECH O., Jr Surgical considerations of dissecting aneurysm of the aorta. Ann Surg. 1955 Oct;142(4):586-610; discussion, 611-2. doi: 10.1097/00000658-195510000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. DeBakey M. E., McCollum C. H., Crawford E. S., Morris G. C., Jr, Howell J., Noon G. P., Lawrie G. Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically. Surgery. 1982 Dec;92(6):1118–1134. [PubMed] [Google Scholar]
  16. Griepp R. B., Stinson E. B., Hollingsworth J. F., Buehler D. Prosthetic replacement of the aortic arch. J Thorac Cardiovasc Surg. 1975 Dec;70(6):1051–1063. [PubMed] [Google Scholar]
  17. Kouchoukos N. T., Marshall W. G., Jr, Wedige-Stecher T. A. Eleven-year experience with composite graft replacement of the ascending aorta and aortic valve. J Thorac Cardiovasc Surg. 1986 Oct;92(4):691–705. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES