Treatment of aortic aneurysms by wrapping with foreign body.

The distorted anatomy, invasive tendencies, large size, and friable thin walls of both syphilitic and arteriosclerotic aontic aneurysms contraindicate any attempt at extensive surgical mani pulation in the form of resections and anastomoses of these aneurysms. The pounding, pulsating pressure exerted by these aontic dilatations presents an almost malignant tendency to in vade and penetrateany adjacentsofttissue.Even the wallsof the bony thorax can be eroded by an expanding pulsating aneurysm. The intense foreign body reaction produced by cellophane and impure polythene film with its constricting fibrosis seems to offer the simplest and most satisfactory method of at least curbing the expansion of these aneurysmal dilatations. This possibility was suggested by the report of Harrison and Chandy' who had grad ually eliminated two arteniovenous aneurysms of the subclavian vessels by cellophane. Harrison's clinical application of the mate rial resulted from the report of Pearse,2 who had demonstrated the ability of cellophane to produce gradual obliteration of the lumen of Important blood vessels, such as the internal carotid, in the place of the previously devised and somewhat unsatisfac tory clamps and bands. This constricting property of cellophane had been demonstrated originally by Page,3 who used it in 1939 to produce artificial nephnitis and hypertension in dogs by wrapping it around the kidneys. A dilemma arose, however, from the reports of McKeeven4 and others that cellophane produced no reaction and was suitable for reconstructingtendon sheaths and lining joint spaces.An experimental study was undertaken at Washington University School of Medicine with several chemically different varieties of cellophane and plastic material, supplied through the courtesy of the DuPont de Nemours Company of Wilmington, Delaware. The resultsof thisinvestigationpublished in greaterdetailelse where,5 suggested that a new impure plastic known as Polythene film produced the most intense foreign body reaction, whereas some of the other types produced little if any reaction. This fibrotic