Treatment of abdominal aortic aneurysm by excision and replacement by homograft.

RECENT experiences with the treatment of saccular aneurysms of the aorta have shown that excision of an aneurysm in any portion of the aorta, with aortic suture, is feasible and that operative risk is not great.' Aneurysms of the distal abdominal aorta are in a more favorable position for surgical attack; however, such lesions are almost always caused by arteriosclerosis. The generalized distribution of the causative disease, the age of most persons affected, and the variable prognosis of untreated patients all indicate a more cautious approach in the application of excision in the treatment of arteriosclerotic aneurysms of the abdominal aorta. Nevertheless, the early results with excision of the aneurysm and replacement by homograft are encouraging and seem to establish this as a method of choice when operative treatment is indicated. This paper is a review of the first 14 patients treated by this procedure. The great majority of aortic aneurysms are caused by either syphilis or arteriosclerosis. Occasional aneurysms caused by trauma or bacterial infection resemble in most respects those caused by syphilis. Syphilitic aneurysms are found most commonly in the thoracic aorta and predominantly in the ascending arch; they occur in younger persons usually less than 55 years of age; they are largely saccular aneurysms resulting from a localized rupture. Arteriosclerotic aneurysms, on the other hand,