Aneurysm Papers of the Month - June 1995

Sorry I'm late with the June papers, but my June JVS didn't 
arrive until the first week in July.  Two papers in the issue
are worthy of comment.  I know of papers in J Int Medicine and JCI
that would be excellent sources for this commentary, but one is
off to be bound and the other hasn't reached the library yet.  So,
with apologies, here are the two belated contributions from June.
For July, I will bring you the two papers that I had hoped to 
report this month.

The papers for June 1995 do not offer startling new revelations;
but they emphasize the seriousness of the aneurysm problem, and 
they point out sources of inaccuracy in the routine reporting of
aneurysm dimensions. 

1. Ruptured thoracic aortic aneurysms: A study of incidence and
mortality rates.  Johansson G, Markstrom U, Swedenborg J.  J Vasc
Surg 1995; 21: 985-8.

Abstract (condensed from authors): 

     Background: To study the incidence and mortality of ruptured
thoracic aneurysms (TAA) in a well-defined population.

     Methods:  Retrospective analysis of compliled data from 
multiple registries in Stockholm.

     Results: The incidence of ruptured thoracic aneurysms was
5 / 100,000 in both 1980 and 1989.  Forty-one % of the patients
were alive on arrival at an emergency hospital, but the overall
mortality was 97-100%.

     Conclusion:  The mortality of ruptured TAA is substantial.
To decrease this high mortality rate, efficient screening methods 
must be worked out and characteristics indicating high risk of
rupture must be identified.

Comment by mdt:  This succinct paper speaks for itself.  The
same issues that revolve around screening for the AAA and 
offering elective surgery to patients with small AAA's require
the same thoughtful consideration with respect to the TAA.


2.  Variability in measurement of abdominal aortic aneurysms.
Lederle FA, et al.  J Vasc Surg 1995: 21:945-52.

Abstract (condensed from authors): 

Purpose:  To report interobserver and intraobserver variability
of CT measurements of AAA diameter and to report agreement 
between CT and US (ultrasound) measurements, in the course of 
a large, multi-center, randomized trial on the management of small
AAA's.


Methods:  CT measurements from participating centers were compared
with measurements made from the same scan by the central lab.  
Blinded remeasurement in the central lab was used to assess 
intraobserver variability.  Agreement between CT and US was also
assessed.

Results:  For interobserver pairs (local vs central, n = 806), 17%
differed by at least 0.5 cm.  For intraobserver pairs (central vs
central, n = 70), only one differed by 0.5 cm.  Local measurements
showed a marked preference for recording by half centimeter.

Conclusion:  Variations in AAA measurement of 0.5 cm or more are
not uncommon.  The authors suggest several ideas with the goal of
reducing variation in measurement, which might be useful in 
important management decisions.

Comment by mdt.  Take a look at this paper for a rather astonishing
graphic (Fig 1B).  Local readings of size pop up with amazing 
frequency at 4.0, 4.5, and 5.0 cm.  Not to suggest that local
readers are deliberately imprecise, but there is certainly a strong
tendency to round off to the nearest 0.5 cm.  You'll have to look
at the graphic to see how impressive these data are.

So long 'til July, when I hope to review two papers that appear to
be very important, at least by title.