Juergens, John L.

The clinical features and follow-up data on 107 patients who had a clinical diagnosis of aneurysm of the thoracic aorta made at the Mayo Clinic in the period 1945 through 1955 were reviewed. The ratio of male to female was 2.8 to 1, and the average age at the time of diagnosis was 59.3 years. Fusiform aneurysms were four times as frequent as saccular aneurysms; the most common location of the former was the descending thoracic aorta and of the latter the ascending thoracic aorta. Most of the aneurysms (73 per cent) were probably arteriosclerotic in origin. Symptoms, usually pain, and physical signs were present in a minority of patients and indicated a large aneurysm with a poor prognosis. Diastolic hypertension was present in almost half of the patients at the time of diagnosis and had an adverse effect on the patient's survival. Associated arteriosclerotic cardiovascular disease was present in 40 (37 per cent) of the patients at the time of diagnosis; some of these patients had multiple associated cardiovascular lesions. The presence of associated coronary, cerebral, or other peripheral arterial occlusive or aneurysmal disease had the most deleterious effect on survival. The prognosis for patients with large aneurysms was poorer than for those with small aneurysms. Information as to the cause of death was available in 59 (83 per cent) of the 71 patients known to be dead at the time of follow-up. Approximately a third of the deaths were due to rupture of the thoracic aortic aneurysm, and approximately a half, to associated cardiovascular disease, particularly that due to arteriosclerosis. It is believed that this study of patients with untreated aneurysms of the thoracic aorta may be used as a guide to the selection of patients with aneurysm for surgical treatment and may serve as a basis for evaluating the long-term results of such treatment.

Of 141 patients with abdominal aortic aneurysms diagnosed at the Mayo Clinic from 1950 through 1959 who were not operated on, follow-up information was obtained from 137 patients (97.1 per cent). Of those followed 1 year or more, 87.6 per cent survived 1 year or more; 52.5 per cent survived 3 years, and 36.4 per cent survived 5 years after diagnosis. These results indicate that the prognosis of abdominal aortic aneurysm in this selected group of patients was somewhat better than that previously reported. The prognosis and survival of patients who had a history of associated cardiovascular disease at the time of diagnosis of aneurysm is distinctly less good than those of patients who had no such history. Of those with such a history, 75.0 per cent survived 1 year, 33.3 per cent survived 3 years, and 20.0 per cent survived 5 years. Of those without such a history 95.7 per cent survived 1 year, 63.2 per cent survived 3 years, and 50.0 per cent survived 5 years. Patients with abdominal aortic aneurysms and associated cardiovascular diseases are more likely to die of cardiovascular complications other than ruptured aneurysms. Patients with abdominal aortic aneurysms who have no evidence of associated cardiovascular disease are more likely to die from a ruptured aneurysm than from anything else. It would appear that small asymptomatic abdominal aortic aneurysms in patients with associated cardiovascular disease may be carefully observed until signs of expansion of the aneurysm or symptoms from the aneurysm appear.

The clinical and follow-up data on 520 non-diabetic patients less than 60 years of age who had a clinical diagnosis of arteriosclerosis obliterans of the lower extremities made at the Mayo Clinic in the period 1939 through 1948 were reviewed from the standpoint of pathogenesis, prognosis, and clinical course of the disease. The ratio of males to females was 11 to 1, and the mean concentration of plasma cholesterol in the male patients with arteriosclerosis obliterans was approximately 50 mg. per 100 ml. greater than that of either of 2 control groups of men without clinical evidence of atherosclerosis. The incidence of smoking among the men with this disease was higher than in a comparable group of men without it. Obesity was not commonly associated with arteriosclerosis obliterans, while hypertension was associated with the disease about 3 times as often as in a control group without the disease. The survival rate for patients with arteriosclerosis obliterans was less favorable than that of a normal population of a similar age and sex distribution, and the survival rate for patients with atherosclerotic aorto-iliac occlusion was significantly less favorable than that of patients with atherosclerotic occlusion of the femoral artery. In approximately three fourths of the patients who died, the cause of death was thought to be disease of the coronary arteries. The presence of atherosclerosis elsewhere than in the arteries supplying the extremities, as manifested by clinical coronary artery or cerebrovascular disease at the time of diagnosis, had an adverse effect on survival. Four per cent of the patients required amputation of a leg shortly after the diagnosis of arteriosclerosis obliterans was made at the clinic, and an additional 4.9 per cent subsequently required amputation during the 5-year period following the initial examination. Only 3.0 per cent of patients with intermittent claudication as the only symptom of their disease required an amputation during this period. Eleven and three-tenths per cent of patients who continued to smoke, but none who abstained from smoking, had amputations within 5 years. Since all patients of the series were treated before the advent of direct arterial surgery for segmental arterial occlusion, it is believed that the subsequent course of the disease in these patients may be used as a basis for comparative evaluation of results in patients subjected to direct arterial surgical procedures.