Traumatic aortic aneurysm: excision and anastomosis without a graft.

usually occur at the aortic isthmus. Typically, the patient is relatively young, free of diffuse vascular disease and the aneurysm arises frorn a linear, transverse disruption of the intima and media, with no significant loss by dissection of adjacent normal vessel. The basic therapeutic challenge, therefore, simply consists of the necessity of restoring continuity of normal aortic wall after the redundant adventitia forming the aneurysm has been excised. Since there has been no loss of substance and the adjacent aorta has the normal elasticity seen in a young adult, restoration of continuity without a graft should he possible in the majority of instances. This concept of the surgical management of traumatic aneurysm has been employed successfully in at least six instances,” placing the rationale of the approach on a firm footing. A therapeutic concept which seems so obvious in retrospect offers an interesting opportunity to examine the reasons for the delay in its use. In the evolution of the surgical therapy of aneurysms of the thoracic aorta during the past decade, tangential excision of sacciform aneurysms of all types was soon followed by definitive treatment of aneurysms requiring graft replacement, employing shunts and hypothermia to prolong the safe aortic occlusion time. A review of the surgical experience in the treatment of traumatic aneurysm during this period suggests that no special significance was attached to the pathologic leatures of traumatic aneurysm which distinguish it from those of luetic, arteriosclerotic, and others of generalized vascular disease origin, in planning the excisional therapy. During this developmental period, the surgeon was preoccupied by the technical problems inherent in the location of the pathology to be treated, and by the proper selection of prosthetic material, a field simultaneously undergoing rapid evolutionary change. The nuance of whether a graft was necessary hardly seemed appropriate in this context.