The Aneurysm Information Project

  • To return to the home page, click here
    
    Papers of the Month - August 1998
    
    1. Two cautionary tales regarding late complications of
    endovascular repairs appeared in the July issue of the
    Journal of Vascular Surgery:
    
         1) Torsello et al.  Rupture of AAA previously
    treated by endovascular stentgraft.  JVS 1998; 28: 184-7.
    
         In brief, the patient was a 76 y/o on Coumadin after
    aortic valve replacement, who ruptured 16 months post-
    endograft.  Seven months after stentgraft repair, there
    had been no evidence of endoleak.
    
         2) Alimi et al.  Rupture of an AAA after
    endovascular graft placement and aneurysm size reduction. 
    J Vasc Surg 1998; 28: 178-83.
    
         This patient ruptured "9 months after a bifurcated
    endovascular graft placement, despite a greater than 45%
    reduction in size noted on contrast-enhanced computed
    tomography scan performed at 7 months."  The authors
    believe that a "secondary detachment of the left limb
    tube from the short limb of the main part of the device"
    may have resulted from "degradations  both the
    textile structure and the stent shape."
    
         Comment by mdt: These reports dramatize the dilemma
    faced by physicians and surgeons who are called on to
    advise patients about which approach is the best choice
    for themselves.  The trade off for perhaps a lower
    initial risk and more rapid recovery from the
    endovascular method is a less durable operation for the
    long run, at least at the present state of the art.
    
    2. Scott RAP et al.  AAA rupture rates: A 7-year follow-
    up of the entire AAA population detected by screening. 
    J Vasc Surg 1998; 28: 124-8.
    
         Abstract (Abridged from authors): 218 AAA's were
    detected by ultrasound among a family practice population
    of 5394 men and women aged 65-80.  Subjects with AAA < 6
    cm were followed by ultrasound according to protocol. 
    Patients were offered surgery if 1) symptomatic; 2) if
    AAA expanded > 1 cm/yr; or 3) If AAA diam reached 6 cm.
    
         Results & Conclusions: The actual rupture rate plus
    elective surgery rate for small AAA's (3-4.4 cm) was 2.1%
    per year.  The equivalent rate for 4.5-5.9 cm AAA's was
    10.2% per year.  
    
         Comment by mdt: Since the authors chose to stratify
    at 4.4 vs 4.5 to compare smaller vs larger AAA's, the
    results cannot be directly compared with the Univ Vermont
    data, which grouped AAA's into < 4cm, 4.0-4.9 cm, >5 cm
    subsets.  However, there is a high level of agreement
    that rupture risk increases substantially toward the
    higher ends of the ranges under study.