From January 1987 to October 1992, 60 consecutive patients operated on for infrarenal abdominal aortic aneurysm (AAA) were reviewed to evaluate the effect of previous laparotomies giving on the results of aneurysmal surgery. Eleven of 60 patients had previous laparotomies. Two of them required emergency operation for ruptured aneurysms. One of them died during surgery as a result of excessive hemorrhage prior to cross-clamping the aorta. Severe peritoneal adhesion had made if difficult to properly expose the aorta for cross-clamping to control hemorrhage. There were no statistical significance in mortality between the previous laparotomy and non-laparotomy groups. Excluding ruptured cases, we compared the previous laparotomy group (9 patients) and non-laparotomy group (37 patients) with reference to perioperative factors, including operation time, blood loss, non-oral feeding days, bed-ridden days, and hospital stay but there were no statistically significant differences. These results suggested that previous laparotomy is not a serious risk factor in operations for AAA.

Fifteen consecutive patients with true or dissecting aneurysms of the thoracic descending aorta, and thoraco-abdominal aorta were operated upon under left thoracotomy with the support of partial cardiopulmonary bypass, equipment composed of a membrane oxygenator, centrifugal pump, and percutaneous thin wall cannulae which were all coated with covalently bonded heparin. The polyvinyl tube was coated with Biomate. The administration of systemic heparin was determined by an ACT of around 200 seconds. One perioperative death in a case treated by emergency operation for a ruptured descending aortic aneurysm occurred due to acute myocardial infarction. Other patients tolerated their operation well and are alive. No thromboembolic accident, bleeding tendency, nor organ failure were observed postoperatively in any other patients. In conclusion, the cardiopulmonary bypass using an antithrombotic circuit is safe and recommendable for thoracic descending or thoraco-abdominal aneurysm operations.