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Aneurysm Papers of the Month - July 97
JC Chen, HD Hildebrand, AJ Salvian, YN Hsiang, DC Taylor.
Progress in abdoiminal aortic aneurysm surgery: four
decades of experience at a teaching hospital.
Cardiovascular Surgery 1997; 5: 150-6.
Abstract (mostly from the authors'):
This paper analyzes all AAA surgical outcomes in 1604
operations from 1955 through 1993 at the Vancouver
Hospital and Health Science Centre in British Columbia.
# of procedures per year increased from 18 to 67. The
intact to ruptured ratio increased from 2.4/l to 3.4/1.
Among intact AAA's: patients over age 80 increased (12-
>24%), prevalence of small AAA's increased (16->54%),
intraop hypotension decreased (9.0% -> 0.7%, and
postoperative amputation rate decreased from 3 -> 0 %).
Periop mortality decreased from 17% -> 3%.
For ruptures, there was a significant increase in rate of
operation in < lhr of admission; a significant decrease
in intraoperative hypotension; and a significant decrease
in venous injury. Notwithstanding these improvements,
mortality remained high (54% -> 44%), perhaps because the
population is older with more co-morbidities or because
an increased # of rupture victims reach the hospital
alive.
Comment by mdt: As the authors observe, these advances
represent major improvements in the surgical care of the
AAA patient. They suggest that, while early results
appear promising in selected patients with endovascular
grafts, "widespread recommendation should be withheld
until results are shown to be comparable with
conventional repair."
And I agree.