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Aneurysm Papers of the Month - March 97
1. MR Moon, RS Mitchell, MD Dake, CK Zarins, JI Fann, DC
Miller. Simultaneous abdominal aortic replacement and
thoracic stent-graft placement for multilevel aortic
disease. JVS 1997; 25: 332-40.
ABSTRACT (abridged from authors): Patients with
aneurysmal disease involving both the descending thoracic
and abdominal aorta have historically required
simultaneous or sequential conventional operations, but
the morbidity rate is high with either approach. Since
Jan 94 the authors have treated 18 such patients with an
endovascular stent-graft in the desc thor aorta through
a side limb fashioned on the abdominal graft at the time
of open surgery. One patient died, resulting in a
hospital mortality rate of 6%. Seventeen are currently
well at an average of 14 months following surgery.
Comment by mdt: Good work! The authors point out in the
discussion that the master aortic surgeon, Stan Crawford,
observed that in a personal series of 112 isolated desc
thor aneurysm repairs, among the 10 patients who died
within 30 days of operation, 3 of these died of a
ruptured AAA. Thus, Crawford came to the conclusion that
the repairs should be done simultaneously. The operative
mortality with this approach in his hands was reduced
from 16% (staged) to 10%. The present results represent
an improvement over these historically important
achievements.
2. JW Hallett Jr, DM Marshall, TM Petterson, DT Gray, TC
Bower, KJ Cherry, P Gloviczki, PC Pairolero. Graft-
related complications after AAA repair: Reassurance from
a 36 year population-based experience. JVS 1997; 25:
277-86.
Bottom line, very highly condensed from authors: "... the
vast majority of patients who undergo standard surgical
repair of an AAA remain free of any significant graft-
related complication during their remaining lifetime(s)",
specifically, KM 5- and 10-year complication-free
estimates were 98% and 96% for false aneurysms, 98% and
95% for erosion/infection, & 98% and 97% for thrombosis.
Comment by mdt: The stable county around the Mayo clinic
allows wonderful opportunities for long-term follow-up of
surgical results. The surgeons at Mayo are a splendidly
talented group, but reports of long-term results were
sometimes greeted with some skepticism because so many
patients travelled from afar; accordingly, the Clinic
might not be well-informed about their long-term
outcomes. By focusing on the local population, the Mayo
has been able to address this criticism; because they are
the only show in town, and follow-up information is local
and easily determined.