H. Edward Garrett

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%.

Surgical considerations of massive gastrointestinal tract hemorrhage caused by aortoduodenal fistula

Abstract Fifteen cases of primary or secondary aortogastrointestinal tract fistula, secondary to abdominal aortic aneurysms or previous aortic grafting procedures, have been seen among approximately 3,000 patients treated for various abdominal aortic lesions in the Baylor University College of Medicine Affiliated Hospitals. Two patients died without benefit of surgery. Thirteen fistulas were repaired with eleven initially successful results. Two delayed deaths occurred, one at ten days and one at four months after operation. Successful surgical repair was performed nine times in eight patients. Aortoduodenal fistulas were corrected in one patient on two separate hospital admissions nineteen months apart. The remaining patients have been asymptomatic six months to six years following operation. The diagnosis of aortogastrointestinal tract fistula should be considered in all instances of gastrointestinal tract hemorrhage, particularly in patients with previous aortic reconstructive surgery or a known abdominal aortic aneurysm. Once this diagnosis is suspected, immediate surgical therapy is mandatory. Prevention following aortic reconstructive procedures consists in the use of improved synthetic grafts, such as Dacron, and the interposition of viable tissue between the graft and the posterior wall of the duodenum.

Surgical Significance of Angiographic Patterns in Coronary Arterial Disease

A review of 313 selective cine coronary arteriograms performed in patients with angina pectoris is presented. Classification of coronary arterial disease by location and severity of stenosis has established certain patterns of disease. Significant disease (greater than 75% stenosis of at least one major vessel) occurred in 270 of 313 (89%) patients. Significant single-vessel disease occurred in only 58 of 270 (23%) patients, while the occurrence of significant multiple-vessel disease was: double, 110 of 270 (40%) patients; triple, 78 of 270 (29%) patients; and quadruple, 24 of 270 (9%) patients. The distribution in 191 arterial occlusions was: right coronary, 101 of 191 (53%); anterior descending, 64 of 191 (33%); and circumflex, 26 of 191 (14%). Anterior and anterior-lateral myocardial ischemia occurred in 80 of 270 (29%) patients, isolated posterior myocardial ischemia in 46 of 270 (18%) patients, and equal anterior and posterior ischemia in 144 of 270 (53%) cases. The angiographic studies were correlated with clinical history and electrocardiographic findings.The frequency of severe posterior myocardial ischemia, either alone or in conjunction with severe anterior ischemia, indicates the need for selective posterior or total myocardial ischemia, either alone or in conjunction of patients are to benefit from myocardial revascularization.