Saccular aortic aneurysms.

Most vascular surgeons believe that saccular aortic aneurysms have a more ominous natural history than the typical fusiform aneurysm, although this is not documented in the literature. Expeditious repair is indicated for symptomatic saccular aneurysms, and intervention is usually advocated even when they are asymptomatic because of the general belief that their unique shape predisposes them to rupture. The objective of this report is to review the presentation and surgical management of this uncommon pathology. The records of 10 patients who underwent surgical intervention for an aortic saccular aneurysm between 1985 and 1998 were reviewed. To summarize their presentation and management, we grouped patients according to anatomic location: group A (distal arch), group B (descending thoracic aorta), group C (visceral aorta), and group D (infrarenal aorta). From analysis of these data we conclude that although saccular aortic aneurysms are rare, when present, they are most commonly found in the thoracic and suprarenal aorta. Most cases treated with surgery are symptomatic. Most thoracic and suprarenal saccular aneurysms can be repaired with a patch graft, which spares thoracic intercostals. Repair of saccular aneurysms of the distal arch are only feasible when performed with the use of hypothermic circulatory arrest. Infrarenal saccular aneurysms generally require tube graft replacement because the coexistent atherosclerosis makes patch repair difficult. Endovascular techniques may be the procedure of choice in the future.