Medicine: Sheriff's Graft

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The patient admitted to Houston's Methodist Hospital on New Year's Eve was 46, a county sheriff by occupation and a fine figure of a man. But for months he had had such severe pains in his back and belly that he had to be given opiates several times a day. Drs. Michael E. De Bakey and Denton A. Cooley found from X rays that the sheriff had a massive aneurysm of the descending aorta—an enlargement of the great artery which carries blood from the heart to the abdomi nal organs and the legs. The aneurysm, formed where the artery's walls had been weakened by disease, was so big (8 in. across) that it was pushing organs out of place and was wearing away part of the sheriff's spine.

There was nothing to do but cut out the length of distorted aorta and replace it with an arterial graft—an operation which was unthinkable until a few years ago. Recently, however, with the setting up of artery banks, more and more daring surgical feats of this type have succeeded. In last week's A.M.A. Journal, the two Houston doctors reported on what they believe is the first successful operation on an aneurysm high in the chest.

Under ether, the sheriff's chest was opened, and the surgeons clamped off the aorta on both sides of the enlargement. As soon as they removed enough of the mass to give themselves working space, they cut the aorta at each side. Into the gap they stitched a 6-in. piece of aorta taken from another patient, a Negro who had died of injuries a few days earlier. It took 45 minutes from the time the clamps shut off the blood flow to the lower organs for the surgeons to stitch the graft in place and remove the clamps, letting the blood flow resume. (The whole operation took 4½ hours.) The sheriff's brain was never threatened, as it received its normal blood supply from a higher-branching artery. And the interruption in blood flow did not even damage his kidneys. This, said the doctors, means that the operation is safer and can be done more easily than might have been expected.

Attesting the success of the operation, the sheriff was back on the job within six weeks, and at last reports was free of pain, feeling fine and had gained 40 Ibs.