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Aneurysm Papers of the Month - April 1995
1. Endovascular repair of AAA's and other arterial lesions.
JC Parodi. J Vasc Surg 1995; 21: 549-57.
Abstract (condensed from author):
Methods: Between Sept 1990 and April 1994, the author treated
57 patients with an endovascular stented graft (EVSG). There were
50 AAA's or iliac aneurysms, 5 traumatic A-V fistulas, and 2
infected peripheral false aneurysms. The EVSG's were fashioned
from either Dacron or autogenous vein, sutured to a balloon-
expandable stent. The grafts were introduced through remote
arteriotomies, advanced under fluoroscopic control to their sites,
and secured into position.
Results: Forty of the 50 EVSG's in AAA or iliac aneurysm
patients were considered to be successful, even though some
secondary treatment was required in six patients. The ten failures
included four early deaths, one late death, and five leaks. The 5
A-V fisulas and 2 false aneurysms were all successful.
Conclusion: Although this initial experience was promising,
there are still problems that require resolution, and longer
follow-up is needed.
Comment by mdt: In the history of modern vascular surgery, it is
too soon to say whether this achievement by Dr. Parodi will take
its place alongside the first successful homograft repair of an AAA
by Dubost in the early 1950's or the development of successful
prosthetic aortic replacements during the following decade. I
believe that there is a strong probability that these pioneering
endovascular procedures herald a new chapter in the history of the
specialty. However, it is appropriate to observe that this
technology is in its investigative stages; and problems remain to
be resolved, as pointed out by the author in his conclusion, before
the procedure can be generally adopted and recommended.
2. Aneurysms of the abdominal aorta: familial and genetic aspects
in three hundred thirteen pedigrees.
A Verloes, N Sakalihasan, L Koulischer, and R Linet (Liege,
Belgium). J Vasc Surg 1995; 21: 646-55.
Abstract (condensed from authors):
Methods: Familial data on 324 probands with AAA's allowed
establishment of 313 multigenerational pedigrees, including 39 with
multiple affected patients.
Results: The relative risk for male siblings of a male
patient was *18*. A segregation analysis suggested that the most
likely explanation for occurrence of AAA in these families was a
single gene effect showing dominant inheritance. The frequency of
the morbid allele was 1/250, and its age-related penetrance was not
higher than 0.4.
Conclusion: This analysis indicates the preeminence of
genetic factors on multifactorial/environmental effects in the
pathogenesis of AAA.
Comment by mdt: A lot of water has passed under the bridge since
Clifton reported the first cluster of siblings in 1977 and we
reported on 16 families with clustering at the meeting of the Amer
College of Surgeons in 1982. By the time that we reported on 50
families in 1984, we had come to the conclusion that if there were
only one major aneurysm locus, it was likely to be autosomal
dominant, based on the frequency of families with father -> son
patterns of inheritance. The present paper is one of the finest
entries into the field so far, and it tends to support the
hypothesis that I believe to be most viable. If questionnaire and
phone inquiry in the present study had been supplemented with
ultrasound screening, the penetrance estimate might need to be
revised upward.