George C. Morris

Dissecting Aneurysms of the Aorta

The disorder, dissection and dissecting aneurysms of the aorta, has been recognized and described for several centuries.[1] In his classical treatise on the subject, Shennan[2] in 1934 provided the most extensive investigations and review of previous reports, resulting in the conclusion that the most significant underlying cause of dissection was medial degeneration. The rapidly fatal course of the disease has also long been recognized. In Shennan’s analysis of a collected series, death occurred within twenty-four hours in 58% of the patients. A number of other reports have since been published showing that more than half the patients die within a few weeks and about 90% within a few months after the initial dissection. More recently, Anagnostopoulos and associates[3] found, in a collected series of 963 patients, that death occurred within a week in 70% and within three months in 90%.

Experience with 200 Renal Artery Reconstructive Procedures for Hypertension or Renal Failure

Renovascular hypertension is the most common form of reversible hypertension.An analysis of 200 renal artery reconstructive procedures identified atherosclerosis as the arteriopathic lesion in 83 per cent of cases and fibromuscular hyperplasia in 13 per cent of cases. Bilateral renovascular disease was found in 31 per cent of cases.Renal arteriography is the most significant factor in the diagnostic evaluation of the hypertensive subject.Bypass graft and patch-graft angioplasty were the most commonly employed principles of renal artery reconstruction in this series.The occlusive process in the renal artery produced a pressure gradient exceeding 25 mm. Hg in 76 per cent of cases.The average period of observation following operation in these 200 patients was 1.6 years, ranging between 3 months and 5 years. Eighty per cent of patients are now normotensive.The primary goal of operation in 12 patients was reversal of renal failure due to severe bilateral renal artery occlusive disease. Disappearance of azotemia with improved renal function followed revascularization in 11 of 12 patients.

Surgical Considerations of Aneurysms and Atherosclerotic Occlusive Lesions of the Aorta and Major Arteries

This report is an analysis of aneurysms and atherosclerotic occlusive lesions based on the treatment of 3,324 patients in the past 10 years.Symptoms were relieved and pulses restored in 97 per cent of aortAiliac occlusions, 90 per cent of femoropopliteal occlusions, 95 per cent of operable lesions of the internal carotid artery, and 91 per cent of vertebral arterial occlusions.Mortality in 116 aneurysms of the descending thoracic aorta was 20 per cent, in 62 dissecting aneurysms 29 per cent, and in 829 aneurysms of the abdominal aorta 6 per cent.

Renovascular hypertension. Experience with renal artery reconstruction in 115 patients.

Abstract Renovascular hypertension as produced by narrowing of one or both renal arteries is the most common surgically curable form of unremitting high blood pressure. Frequently, renal artery constriction is produced by atherosclerosis, usually localized in the proximal arterial segment. Other forms of renal artery narrowing include fibromuscular intimal and medial hyperplasia, as commonly observed in young patients, and aneurysms of the renal artery. Selection of hypertensive patients for renovascular study or operative treatment is fundamentally a matter of exclusion. Subjects with serious cerebrovascular insufficiency or coronary artery disease make poor candidates for surgical reduction of arterial pressure. Renal arteriography is the cardinal feature in the diagnostic study of patients with severe hypertension. Selection of technic for renal artery reconstruction depends upon varying anatomic and pathologic considerations. In this surgical series of 115 hypertensive patients renal artery bypass and patch graft angioplasty were the methods of renal revascularization most frequently used. Blood pressure following operation ultimately became normal in 80 per cent of patients, and significant improvement was observed in an additional 8 per cent.

Aortic aneurysms and occlusive diseases of the aorta

Abstract Aneurysms and occlusive disease are the principal lesions of the aorta requiring surgical treatment. Arteriosclerosis is the usual underlying cause of both of these conditions. Diagnosis of aneurysm ordinarily is not difficult; and, in the case of abdominal aneurysms, aortography is rarely necessary. Treatment of aneurysms is based on extirpation of the lesion and restoration of normal vascular continuity. The usual segmental nature of aortic occlusive disease permits surgical treatment designed to restore circulation through normal channels. Surgical cure of both aneurysmal and occlusive defects of the aorta now can be accomplished with assurance of low surgical risk and normal life expectancy.