Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically.

THE DIS~ASI: or dissection and dissecting aneurysms of the aorta has been known since the sixteenth century when it was described in several publications.36x37*4’ In his classical treatise on aneurysms, Scarpa3’ referred to Fernelius” as the first, in 1542, to propose that an aneurysm may be caused by pathologic distension of all the coats of an artery. In 1628, Sennertus3* described aortic dissection but made no distinction between the process and aneurysmal formation. In 1769, Morgagniz9 recorded a clear description of the anatomic and pathologic changes in dissecting aneurysms. A more detailed and accurate description of the disease was presented by Maunoir26 in 1802. The term “dissecting aneurysm” was first designated by Laennec,24 in 1826, as “anivrisme dissequant.” During the remainder of the nineteenth century, a number of investigators reported observations on the pathology, histoanatomy, and pathogenesis, further clarifying the nature of the disease.+ Despite these observations there remained some confusion and uncertainties about the pathogenesis of the disease. Much of this was resolved in 1934 by Shennan4* in his classical treatise on the subject and his extensive investigations resulting in the conclusion that the most significant underlying cause of dissection was medial degeneration. The gravity of the disease with its rapidly fatal course has long been recognized. This was first indi-