Surgical management of aortic abdominal aneurysms in patients with severe pulmonary insufficiency.

In view of the poor prognosis associated with the natural history of aortic abdominal aneurysms, this disorder is being surgically corrected in an increasing number of patients. There remains a group of patients with serious coexisting disease in whom careful consideration must be given concerning the risk of operation. One such group of patients is those with severe respiratory insufficiency. The records of ten patients with clinical and physiologic evidence of severe pulmonary insufficiency and concomitant aortic abdominal aneurysms were reviewed. While some patients were refused operation for severe cardiovascular disease, malignant disease and obesity, none was denied operation on the basis of severe respiratory insufficiency alone. With detailed respiratory assessment, appropriate preoperative preparation and careful attention to pulmonary function in the postoperative course, these patients can now undergo aortic abdominal aneurysm resection and grafting with a high expectation of success. In the ten patients, no operative deaths occurred, and all were discharged from the hospital having undergone a favorable postoperative course.