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1. Harris PL, et al. Incidence and risk factors of
late rupture, and death after endovascular repair of
infrarenal aortic aneurysms: The EUROSTAR experience.
J. Vasc. Surg. 2000; 32: 7349-49.
Abstract, adapted from authors. The Eurostar (European
Collaborators on Stent/graft techniques for aneurysm
repair) Registry was established in 1996 to collect
data on the outcome of endovascular AAA treatment. By
March 2000, 2464 patients had been registered, with
mean duration of followup was 12.19 months. There were
14 patients with confirmed rupture (5 survived
emergency operation). The cumulative risk of rupture
was calculated to be 1% / year. 41 patients underwent
late conversion to open repair (with a 75.6 mortality
rate). The cumulative risk of late conversion was
approximately 2% / year. Thus, the risk of late
failure, according to analysis of observed hard
endpoints, was 3 % / year. The authors present
extensive data on analysis of causes of late failure in
hopes of improving results in the future.
Comment by mdt: A *very* impressive series. We are
now beginning to learn the natural history of
endovascular grafts based on multi-institutional trials
with large numbers of observed patients.
2. Valentine, RJ, et al. Watchful waiting in cases of
small AAA -- appropriate for all patients?
One-hundred and one male military veterans with AAA < 5
cm were observed over time in the present study. Sixty-
nine were fully compliant with follow up examinations,
and none died with rupture (mean follow up 34 months).
25 developed indication for repair over that time, and
36 did not. Among the non-compliant patients, three
and possibly four died with rupture. The authors
conclude that noncompliant patients present a special
problem, and they may be candidates for earlier
intervention.
Comment by mdt: I think the authors are right,
especially considering the improving results with
endovascular repair (as in the EUROSTAR trial). The
only problem I see is that it is not always easy to
tell who will become non-compliant, until they become
non-compliant.