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Jack L Cronenwett

Publications and source records attributed to Jack L Cronenwett.

At least 19 recordsLinked to original sources
PubMed2006

Comparison of embolization protection device-specific technical difficulties during carotid artery stenting.

BACKGROUND: Embolic protection devices (EPDs) consisting of an internal carotid artery (ICA) filter or balloon occlusion are typically used during carotid artery stenting (CAS). This study compares the technical difficulties encountered using these two types of EPD. METHODS: A retrospective review was conducted of patients undergoing CAS using a balloon occlusion EPD (balloon group: PercuSurge GuardWire) or filter EPD (filter group: Accunet, AngioGuard, or FilterWire). Complications were defined as minor stroke, National Institutes of Health (NIH) stroke scale <3; major stroke, NIH stroke scale > or =3; transient ischemic attack (TIA), reversible focal neurologic impairment; technical, reversible neurologic compromise during EPD deployment, inability to cross lesion, ICA spasm requiring treatment, EPD-related factors that prolonged CAS. RESULTS: CAS (n = 141) was performed in 133 patients (82% men) with a mean age of 72 of years. Comorbidities included diabetes, 35%; coronary artery disease, 75%; hypertension, 82%; and renal insufficiency, 15%. Indication was previous cerebrovascular accident in 10%, TIA in 29%, and asymptomatic >80% stenosis in 61%. Primary lesions were treated in 83% vs restenosis in 17%. The 30-day event rate was 1.4% major stroke, 2.1% minor stoke, 1.4% myocardial infarction, and 0.7% death. The overall combined 30-day stroke, death, and myocardial infarction rate was 5.6%. The 30-day stroke and death rate was 4.0% in the balloon group (n = 99) and 4.6% in the filter group (n = 42, P = .51). EPD-related technical difficulties occurred in 15% of the balloon group and 31% of the filter group (P < .05). Technical difficulties included a 10% incidence of reversible neurologic compromise during balloon deployment compared with 0% in the filter group (P = .002) and 12% incidence of inability to cross the lesion before predilation in the filter group compared with 0% in the balloon group (P = .001). CONCLUSIONS: During CAS, both balloon occlusion and filter devices provide acceptable results and appear complimentary. Filters can be used preferentially to avoid a 10% incidence of reversible neurologic compromise associated with balloon occlusion, except in critically narrowed or tortuous lesions when balloon occlusion may be preferred because of a 12% need for unprotected predilatation with filters.

Aged↗
PubMed2006

Vascular surgery training: is there enough case material?

In recent years, vascular surgery fellowships have changed substantially to meet the requirements for interventional as well as open surgical training. Data from the Residency Review Committee for Surgery indicate that the average vascular fellow performed fewer than 15 interventional procedures in 2000, but that this volume had increased to more than 200 interventional procedures by 2005, an increase of 255%. During the same interval, there was a slight (4%) decrease in the average number of major open vascular reconstructions performed. In 2005, the average vascular fellow performed 450 primary procedures, nearly equally divided between open and interventional cases. Selected open operations, such as aortic aneurysm repair, have decreased in volume due to the substitution by endovascular procedures. Operative volume for vascular fellows has been preserved in part by a 19% reduction in major vascular operations performed by general surgery residents. However, with added overall volume due to the increased prevalence of vascular disease in the aging population, there appears to be adequate case material to train future vascular surgeons, as long as less commonly performed operations continue to be focused on vascular trainees.

Aneurysm↗
PubMed2005

Outcomes of renal artery angioplasty and stenting using low-profile systems.

OBJECTIVE: Renal artery percutaneous transluminal angioplasty (RPTA) and stenting (RAS) are accepted therapies for selected patients with renovascular hypertension and chronic renal insufficiency. We evaluated the outcomes and complications of RAS performed by vascular surgeons at our institution with modern low-profile systems. METHOD: We retrospectively analyzed all RPTA and RAS procedures attempted with the use of low-profile systems from June 2000 to September 2003. Eighty-two patients (96 arteries) with atherosclerotic renal artery stenosis were treated. Indication for treatment was hypertension in 44 (54%) and chronic renal insufficiency in 38 (46%). Technical success, complication rates, clinical success for control of hypertension or renal insufficiency, restenosis, and survival were reviewed with a mean follow-up of 1 year. RESULTS: Ninety-three arteries were treated with stents, three with RPTA only. Primary technical success was 95%, with 98% overall technical success. Major complications occurred in 6.1% and minor complications in 1.2%. Hypertension was improved in 81% at 1 year. Renal function was improved in 23%, stable in 53%, and worse in 24% at 1 year. Restenosis was seen by routine duplex surveillance in 25% at 1 year. Restenosis associated with clinical deterioration and confirmed by angiogram was seen in 10%. The overall 3-year survival was 83%. CONCLUSION: RPTA/RAS can be performed with low-profile systems with excellent technical success, low complication rates, and clinical outcomes that compare favorably with prior reports.

Angioplasty, Balloon↗
PubMed2005

Restenosis in gold-coated renal artery stents.

BACKGROUND: Gold coating improves stent visibility under fluoroscopy. This is particularly valuable for precise stent placement during renal artery stenting (RAS). There is conflicting evidence regarding restenosis with gold-coated stents. To evaluate the effect of gold coating on restenosis after renal stenting, we reviewed the results of all patients undergoing RAS in our practice. METHODS: A retrospective cohort study of all patients undergoing RAS between June 2000 and September 2003 was performed. During this time, both gold-coated and stainless steel stents were used. Restenosis (>60% diameter) was determined by serial follow-up duplex exams (peak systolic velocity >180 cm/s and renal-aortic ratio >3.5). Restenosis rates were determined by using the Kaplan-Meier life-table method. Variables potentially affecting restenosis were evaluated with the log-rank test and Cox proportional hazards modeling. RESULTS: RAS was performed in 97 arteries (78 patients). Gold-coated (NIRoyal) stents were placed in 59 arteries (48 patients). Stainless steel stents (Corinthian, Genesis, and Herculink) were placed in 38 arteries (34 patients). Patient demographics, indication for treatment, technical success, and complications did not differ between gold and stainless steel stent groups. Mean follow-up was 15 months for gold-coated stents and 18 months for stainless steel stents (NS). By life-table method, 1-year and 2-year freedom from restenosis rates were 84% and 78% in arteries treated with stainless steel stents versus 69% and 39% in those treated with gold-coated stents (P = .012, log-rank test). By multivariate analysis, only the use of gold-coated stents (P = .018; hazard ratio [HR], 3.3; 95% confidence interval [CI], 1.2 to 8.7) and bilateral disease (P = .046; HR, 2.3; 95% CI, 1.02 to 5.2) predicted restenosis. Stent diameter, patient demographics, and indication for RAS had no effect on restenosis by univariate analysis. According to American Heart Association criteria, 87% of patients in the stainless steel group had improved blood pressure at 1 year, compared with 77% in the gold-coated stent group (Kaplan-Meier; P = .042, log-rank test). There were no significant differences in the effect of RAS on serum creatinine levels between the two groups. CONCLUSION: Gold-coated renal stents had a substantially higher rate of restenosis than stainless steel stents in our series. These findings have led us to abandon the use of gold-coated stents for RAS. Patients who have received gold-coated stents for the treatment of atherosclerotic renal artery stenosis should be followed closely for evidence of restenosis.

Aged↗
PubMed2005

Mesenteric stenting for chronic mesenteric ischemia.

BACKGROUND: Mesenteric stenting has not been widely adopted for the treatment of chronic mesenteric ischemia (CMI). The recent availability of embolic protection and low-profile devices with the theoretical ability to decrease perioperative bowel necrosis, led us to begin using mesenteric stenting for patients with CMI. We review our initial experience to examine short-term outcomes. METHODS: We performed a retrospective analysis of all patients who were treated by vascular surgeons with mesenteric stenting for CMI. Patients with acute mesenteric ischemia were excluded. We evaluated perioperative morbidity and mortality, restenosis, recurrent symptoms, and reintervention. Kaplan-Meier methods were used to assess events during follow-up. We also compared these outcomes with a historical control group of patients treated with open surgical revascularization. RESULTS: Fourteen patients underwent mesenteric stenting over the past 3 years. Mean age was 73, and 64% were women. There was no perioperative or 30-day mortality or major morbidity. Early restenosis and recurrent symptoms occurred in 10% and 9% of patients at 6 months. At a mean follow-up of 13 months, 53% of patients underwent reintervention. However, 93% were symptom-free at their last follow-up. Compared with open surgery, stent patients had lower perioperative major morbidity (30% vs 0%, P < .01) and shorter hospital and intensive care unit length of stay (median 10 days vs 2 days, and 3 days vs 0 days, respectively, P < .01 for both). However, stent patients were seven times as likely to develop restenosis (P < .01), four times more likely to develop recurrent symptoms (P < .01), and 15 times more likely to undergo reintervention (P < .01). There was one death 13 months after stenting due to mesenteric infarction in a patient lost to follow-up. One patient was successfully converted to open surgery after a second restenosis. He had regained 20 pounds and was determined to be a better operative candidate than at his initial presentation. There was no perioperative or 30-day mortality or major morbidity with reintervention after mesenteric stenting. CONCLUSION: Mesenteric stenting for CMI can be performed with low perioperative risk. However, stenting is associated with early restenosis and recurrent symptoms requiring secondary procedures. Patients with severe nutritional depletion or high surgical risk may benefit from mesenteric stenting for CMI, but close follow-up is required. Later open surgery can be performed for restenosis if nutritional status and surgical risk are improved, or repeat angioplasty and stenting can be effectively performed if operative risk remains high.

Aged↗
PubMed2004

Early results of carotid stent placement for treatment of extracranial carotid bifurcation occlusive disease.

OBJECTIVE: The purpose of this study was to review the initial results of carotid artery angioplasty with stenting (CAS) performed by vascular surgeons to treat bifurcation occlusive disease. Most patients were selected for CAS if they had indications for endarterectomy (CEA) but were considered at high risk for surgery. METHODS: Since December 2000, 74 carotid arteries in 69 patients underwent CAS, with distal balloon embolization protection in 96%. Mean patient age was 72 years; 82% of patients were men. Indications for CAS included asymptomatic disease (62%), transient ischemic attack (TIA; 23%), and cerebrovascular accident (15%). Mean internal carotid artery diameter stenosis was 82%. CAS was chosen over CEA because of cardiac (49%) or pulmonary (4%) comorbid conditions, hostile neck (25%), distal extent of disease (6%), and contralateral cranial nerve injury (1%). CAS was performed in 15% patients who were good surgical candidates, because of patient preference. Pathologic conditions were primary atherosclerosis (81%), recurrent carotid stenosis (18%), and dissection (1%). Procedures were transfemoral in 95% of cases and transcarotid in 5%. In 30% of cases the contralateral carotid artery had 80% or greater stenosis or was completely occluded. RESULTS: Technical success was achieved in 96% of cases. There were no deaths, no major strokes, one minor stroke (National Institutes of Health Stroke Scale, 3), and one TIA (neurologic event rate, 2.6%). The single minor stroke resolved completely by 1 month. One patient (1.3%) had a perioperative myocardial infarction. Transient neurologic changes occurred in 8% of patients during the protection balloon inflation, and all resolved with deflation. Bradyarrhythmia requiring pharmacologic treatment occurred in 14% of patients. At mean follow-up of 6 months there have been two instances of recurrent stenosis greater than 50% as noted at duplex scanning. During the same period, 266 carotid CEAs were performed, with a neurologic event rate of 0.8% (major stroke, 0.4%; no minor strokes; TIA, 0.4%) and a myocardial infarction rate of 3%. Combined stroke and death rate was 1.3% in patients who underwent CAS and 0.5% in patients who underwent CEA. CONCLUSION: CAS with cerebral protection can be performed safely in patients at high surgical risk, with low perioperative morbidity and mortality. The durability of the procedure must be determined with longer follow-up.

Aged↗
PubMed2004

Anatomic characteristics of ruptured abdominal aortic aneurysm on conventional CT scans: Implications for rupture risk.

OBJECTIVE: The purpose of this study was to analyze anatomic characteristics of patients with ruptured abdominal aortic aneurysms (AAAs), with conventional two-dimensional computed tomography (CT), including comparison with control subjects matched for age, gender, and size. METHODS: Records were reviewed to identify all CT scans obtained at Dartmouth-Hitchcock Medical Center or referring hospitals before emergency AAA repair performed because of rupture or acute severe pain (RUP group). CT scans obtained before elective AAA repair (ELEC group) were reviewed for age and gender match with patients in the RUP group. More than 40 variables were measured on each CT scan. Aneurysm diameter matching was achieved by consecutively deleting the largest RUP scan and the smallest ELEC scan to prevent bias. RESULTS: CT scans were analyzed for 259 patients with AAAs: 122 RUP and 137 ELEC. Patients were well matched for age, gender, and other demographic variables or risk factors. Maximum AAA diameter was significantly different in comparisons of all patients (RUP, 6.5 +/- 2 cm vs ELEC, 5.6 +/- 1 cm; P <.0001), and mean diameter of ruptured AAAs was 5 mm smaller in female patients (6.1 +/- 2 cm vs 6.6 +/- 2 cm; P =.007). Two hundred patients were matched for diameter, gender, and age (100 from each group; maximum AAA diameter, 6.0 +/- 1 cm vs 6.0 +/- 1 cm). Analysis of diameter-matched AAAs indicated that most variables were statistically similar in the two groups, including infrarenal neck length (17 +/- 1 mm vs 19 +/- 1 mm; P =.3), maximum thrombus thickness (25 +/- 1 mm vs 23 +/- 1 mm, P =.4), and indices of body habitus, such as [(maximum AAA diameter)/(normal suprarenal aorta diameter)] or [(maximum AAA diameter)/(L3 transverse diameter)]. Multivariate analysis controlling for gender indicated that the most significant variables for rupture were aortic tortuosity (odds ratio [OR] 3.3, indicating greater risk with no or mild tortuosity), diameter asymmetry (OR, 3.2 for a 1-cm difference in major-minor axis), and current smoking (OR, 2.7, with the greater risk in current smokers). CONCLUSIONS: When matched for age, gender, and diameter, ruptured AAAs tend to be less tortuous, yet have greater cross-sectional diameter asymmetry. On conventional two-dimensional CT axial sections, it appears that when diameter asymmetry is associated with low aortic tortuosity, the larger diameter on axial sections more accurately reflects rupture risk, and when diameter asymmetry is associated with moderate or severe aortic tortuosity, the smaller diameter on axial sections more accurately reflects rupture risk. Current smoking is significantly associated with rupture, even when controlling for gender and AAA anatomy.

Aged↗
PubMed2004

Vascular surgery training in the United States, 1994 to 2003.

OBJECTIVE: The purpose of this study was to analyze the use of operative training resources for vascular surgery residents (VSRs) and general surgery residents (GSRs) over the past 10 years in the United States, to address questions concerning adequate endovascular versus open surgical training and the potential to expand the number of VSRs to meet future workforce needs. METHODS: National operative data from the Residency Review Committee for Surgery (RRC) were analyzed for all vascular surgery (VS) and general surgery (GS) training programs from 1994 to 2003. GSR experience in programs with and without associated VS programs was also compared. RESULTS: Mean total VS volume per VSR increased from 220 operations in 1994 to 368 in 2003, owing to the addition of 140 endovascular procedures by 2003. GSR volume was more stable, with 117 mean total VS operations in 1994 and 122 in 2003. This volume was distributed as approximately 50% major open VS operations for both VSR and GSR. In addition, 39% of VSR experience was endovascular, whereas 32% of GSR experience was vascular access. The average VSR performed 2.7 times more major open VS operations than each GSR, but because of the 10-fold greater number of GSRs, VSRs performed only 20% of the total major operations available for VS training. Selective procedures, such as renal revascularization and open infrarenal abdominal aortic aneurysm repair decreased over time, while endovascular abdominal aortic aneurysm repair increased dramatically, accounting for 46% of aortic aneurysm repairs per VSR in 2003. The mean volume of total interventional procedures per VSR in 2003 was 152 diagnostic and 213 therapeutic. GSRs in programs with and without an associated VS program had very similar operative volumes. CONCLUSIONS: Interventional procedures have increased VSR operative volume by 50% in recent years, with only a 12% decrease in major open operations. Nearly all VSRs currently meet RRC minimum requirements for open and endovascular procedures. Mean GSR operative volume has been stable, and far exceeds RRC minimum requirements. Based on the number of major open vascular operations available for training in 2003, the current number of VSR positions could be increased by 50% if GSR operative volume was decreased by 15%. However, increased interventional volume would also be required, for which there is competition with other specialties.

Education, Medical, Graduate↗
PubMed2004

Choice of vascular surgery as a specialty: survey of vascular surgery residents, general surgery chief residents, and medical students at hospitals with vascular surgery training programs.

PURPOSE: Under the direction of the Association of Program Directors in Vascular Surgery, a survey was mailed to vascular surgery residents (VSRs), general surgery chief residents (GS-CRs), and fourth-year medical students (MSs) to better define reasons why trainees do and do not choose vascular surgery as a career. METHODS: Questionnaires were mailed to all accredited VSR programs and their associated GS programs in the United States and Canada in 2001 (survey 1) and in 2003 (survey 2) and to 2 medical schools with VSR programs in 2001. A total of 197 VSRs, 169 GS-CRs, and 78 MSs responded (overall program response rate of 78% for VSRs, 46% for GSRs, 20% for MSs). A scoring system was assigned, with 1.0 the least important and 5.0 the most important reasons to choose or not choose vascular surgery. RESULTS: Technical aspects, role of mentors, and complex decision making involved in vascular surgery were the most important reasons that VSRs, GS-CRs, and MSs would choose vascular surgery as a specialty (average scores > or =4.0 for VSRs and GS-CRs; > or =3.5 for MSs). Responses of GS-CRs and VSRs did not vary significantly between surveys 1 and 2, except endovascular capabilities of vascular surgeons had a more important role in choosing vascular surgery, and future loss of patients to other interventionalists had a more important role in not choosing this specialty in the more recent survey of GS-CRs and VSRs. MSs identified lifestyle as a surgical resident (4.3) and as a surgeon (4.2) as the most important negative factors. A training paradigm consisting of 4 years general surgery + 2 years vascular surgery with a GS certificate was favored by 64% of GS-CRs and 48% of VSRs, compared with a paradigm of 5 years + 2 years with a general surgery certificate, which was favored by 29% of GS-CRs and 25% of VSRs, or 3 years + 3 years without a general surgery certificate, favored by 7% of GS-CRs and 27% of VSRs. Of note, 86% of MSs favored 3 years general surgery + 3 years vascular surgery or 2 years general surgery + 4 years vascular surgery compared with longer general surgery training periods. CONCLUSION: These findings may help vascular surgery program directors devise strategies to attract future trainees. The importance of mentorship to general surgery junior residents and medical students in choosing vascular surgery cannot be overestimated. Endovascular capabilities of vascular surgeons have an increasingly positive role in career choice by GS-CRs and VSRs, but these residents express increasing concerns about potential loss of patients to other specialists. Lifestyle concerns are the most important reasons why medical students do not choose vascular surgery as a career.

Adult↗
PubMed2003

Early results of stent-grafting to treat diffuse aortoiliac occlusive disease.

INTRODUCTION: Diffuse aortoiliac occlusive disease or isolated external iliac artery occlusion >or=10 cm long typically are treated with surgical bypass grafting because of limited durability of stent placement. We evaluated the results of stent-graft placement as an option for treatment of these diseases. METHODS: Demographic data for patients undergoing stent-grafting in one or more iliac artery segments were recorded. Technical, clinical, and hemodynamic success, and aortoiliac primary and secondary patency were analyzed with Society for Vascular Surgery/American Association for Vascular Surgery criteria. RESULTS: Thirty-four consecutive patients underwent stent-graft treatment because of rest pain (65%) or tissue loss (35%). Mean patient age was 63 years, and 38% of patients were women. Ninety-one percent of patients had hypertension, 71% had coronary artery disease, 21% had renal insufficiency (serum creatinine > 2.0 mg/dL), and 26% had diabetes; 71% were active smokers. TransAtlantic Inter-Society Consensus C or D disease was present in 85% of patients, complete common or external iliac artery occlusion was present in 41%, and external iliac artery disease requiring treatment was present in 94% of patients. Mean lesion length was 13.7 +/- 8 cm. Technical, hemodynamic, and clinical success was achieved in all patients in whom the lesion could be crossed with a wire. Ankle-brachial index increased from.30 +/-.03 to.59 +/-.04. Self-expanding stent grafts were used (Wallgraft, Boston Scientific, Boston, Mass, in 88% of patients; Viabahn, W. L. Gore, Flagstaff, Ariz, in 12% of patients). Concomitant common femoral endarterectomy was performed in 53% of patients. At 12 months, primary patency was 70% and primary assisted patency was 88%. Four stent grafts became occluded because of distal external iliac artery or proximal common femoral artery disease, which required subsequent common femoral endarterectomy and either external iliac artery stent grafting or extraanatomic bypass grafting. Eighty percent (four of five) of primary patency failures were in patients who did not undergo concomitant common femoral endarterectomy at initial stent graft placement. CONCLUSION: Early results of stent-graft placement to treat diffuse aortoiliac occlusive disease appear better than our recent experience with stenting alone. Concomitant common femoral endarterectomy or better assessment of femoral disease may improve durability.

Adult↗
PubMed2003

Blinded comparison of preoperative duplex ultrasound scanning and contrast arteriography for planning revascularization at the level of the tibia.

PURPOSE: We examined whether preoperative duplex ultrasound scanning (DU) could replace contrast material-enhanced arteriography (CA) in selecting the recipient artery of tibial or peroneal artery bypass grafts. METHODS: In patients who underwent tibial or peroneal artery bypass grafting because of critical ischemia, images were obtained of the lower extremity arterial circulation with both DU and CA. Vascular surgeons, blinded to the operation performed, reviewed either DU or CA images for arterial visualization and patency. The tibial or peroneal artery best suited to receive the bypass graft was selected by surgeons using only data from either DU or CA images. This selection was compared with the artery actually used at bypass surgery. RESULTS: Preoperative DU and CA data for 40 lower extremities in 38 patients undergoing bypass grafting at the level of the tibia provided 110 arteries: 38 anterior tibial arteries, 32 peroneal arteries, and 40 posterior tibial arteries. Ten arteries (8 peroneal, 2 anterior tibial) were not identified with DU, and 1 artery (anterior tibial) was not identified with CA. DU enabled prediction of the artery actually used in 88% of patients (35 of 40), whereas CA enabled prediction of the artery actually used in 93% of patients (37 of 40; P =.59). Duplicate findings at DU and CA enabled selection of 85% of arteries actually used (95% confidence interval, 71%-93%). Arteries used for bypass grafting had significantly higher peak systolic velocity (35 cm/s vs 25 cm/s; P =.04), higher end-diastolic velocity (15 cm/s vs 9 cm/s; P =.005), and greater diameter (2.4 mm vs 1.7 mm; P =.003) compared with arteries not selected for bypass grafting. CONCLUSION: Findings at DU and CA typically agree when used to select tibial or peroneal arteries for bypass grafting. With DU there is occasional difficulty in identification of the peroneal artery, but selection of the actual artery used is accurate. Peak systolic velocity, end-diastolic velocity, and diameter characteristics correlate with arteriographic criteria for tibial bypass target artery selection. If DU enables adequate identification of a target artery for bypass grafting, and especially if the peroneal artery is seen, findings at CA are not likely to alter bypass execution.

Adult↗
PubMed2003

Endovascular repair of abdominal aortic aneurysm without preoperative arteriography.

OBJECTIVE: Clinical trials of endovascular aortic aneurysm repair (EVAR) have required both preoperative aortography and computed tomography (CT). We codeveloped specialized three-dimensional (3-D) reconstruction and computer-aided measurement, planning, and simulation software (3-D CAMPS) based on CT or magnetic resonance imaging, to eliminate the need for preoperative arteriography. METHODS: EVAR with 3-D CAMPS as the sole preoperative imaging method was performed in 196 patients from 1996 to 2001, with six endograft types in three configurations. Physical examination, abdominal radiography, and CT (3D-CAMPS) were performed at 1, 6, and 12 months, then annually. RESULTS: For a subset of cases in which a comparison could be made, 3-D CAMPS was superior to angiography for prediction of endograft length and iliac access. Hospital mortality was zero, and 30-day mortality was 0.5%. In three patients immediate conversion to open repair (1.5%) was necessary because of previously unknown stent-graft mechanical limits. Incidence of endoleak was 15% at 1 month, 10% at 6 months, 6% at 12 months, and 7% at 24 months, and 92% of endoleaks were type II. Mean follow-up was 18 months. Aneurysm-related mortality was zero. Nineteen secondary procedures (all endovascular) were performed in 16 patients (8%). For all graft types, freedom from secondary procedure was 94% at 1 year and 90% at 2 years, and this was better for endografts ultimately approved by the US Food and Drug Administration (96% at 1 year, 95% at 2 years; P =.02). No known measurement-related complications occurred in the series. Results for secondary intervention and endoleak compare favorably to series with similar endograft types. CONCLUSIONS: EVAR can be performed with 3-D CAMPS as the sole preoperative imaging method to achieve outcomes comparable to the best series published for each endograft type. CT with 3-D CAMPS can effectively eliminate the need for preoperative arteriography and avert associated morbidity, expense, and exposure to contrast agent and radiation.

Aged↗
PubMed2003

Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery.

Decision-making in regard to elective repair of abdominal aortic aneurysms (AAA) requires careful assessment of factors that influence rupture risk, operative mortality, and life expectancy. Individualized consideration of these factors in each patient is essential, and the role of patient preference is of increasing importance. It is not possible or appropriate to recommend a single threshold diameter for intervention which can be generalized to all patients. Based upon the best available current evidence, 5.5 cm is the best threshold for repair in an "average" patient. However, subsets of younger, good-risk patients or aneurysms at higher rupture risk may be identified in whom repair at smaller sizes is justified. Conversely, delay in repair until larger diameter may be best for older, higher-risk patients, especially if endovascular repair is not possible. Intervention at diameter <5.5 cm appears indicated in women with AAA. If a patient has suitable anatomy, endovascular repair may be considered, and it is most advantageous for older, higher-risk patients or patients with a hostile abdomen or other technical factors that may complicate standard open repair. With endovascular repair, perioperative morbidity and recovery time are clearly reduced; however, there is a higher reintervention rate, increased surveillance burden, and a small but ongoing risk of AAA rupture. There is no justification at present for different indications for endovascular repair, such as earlier treatment of smaller AAA. Until long-term outcome of endoluminal repair is better defined and results of randomized trials available, the choice between endovascular and open repair will continue to rely heavily on patient preference.

Aortic Aneurysm, Abdominal↗