Aortic aneurysm operations: past, present, and future.

Effective methods to treat aortic aneurysms are now available, although these lesions still challenge the cardiovascular surgeon. Attempts at treatment began in earnest in the 1800s, with the introduction of indirect and direct methods of repair. A major breakthrough occurred in the late 1800s, when Dr Rudolph Matas devised a method for internal repair of aneurysms in which continuity of blood flow was restored by excising the diseased portion of the lesion and creating a tunnel through the remaining normal portion. Matas named this technique reconstructive endoaneurysmorrhaphy. Until that time, surgeons had treated aneurysms by ligating the parent vessel with a Hunterian ligature or introducing foreign material to promote coagulation. Ligating the aneurysm rendered the extremities vulnerable to ischemic damage, however, and results were unpredictable with the use of various foreign materials. Around the turn of the century, Carrel began experimenting with different techniques for vascular anastomoses. The work of these early pioneers formed the basis for much of the modern treatment of aneurysms of the thoracic 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 early emphasis on excising the lesion to the present practice of restoring circulatory continuity with a suitable graft, ie, endoaneurysmorrhaphy. The development of reliable synthetic grafts has been one of the most important advances in the treatment of aneurysms. The surgical technique used today depends on the anatomic location of the aneurysm, which can occur anywhere from the aortic annulus and aortic valve to the distal thoracic aorta and visceral vessels in the abdomen.