0
Invited Critique |

Percutaneous Endovascular Repair of Ruptured Abdominal Aortic Aneurysms—Invited Critique

Bruce A. Perler, MD, MBA
Arch Surg. 2007;142(11):1053. doi:10.1001/archsurg.142.11.1053.
Text Size: A A A
Published online

Extract

During the past 3 decades, there has been a remarkable reduction in the rate of operative mortality among patients undergoing elective AAA repair, and the introduction of endovascular AAA repair (EVAR) may further reduce operative morbidity in this patient population. Unfortunately, a similar improvement in outcome among patients undergoing emergency open repair of RAAAs has not occurred, and operative mortality continues to approach 50% in many leading centers. In light of that, perhaps one of the most impressive observations in the study by Najjar and colleagues from Northwestern University is the remarkably low incidence of operative mortality, 13.6% (3 of 22), among patients undergoing conventional open RAAA repair. Therefore, one must wonder if there is substantial selection bias in the patient population reported in this series, which should be considered in assessing their experience with EVAR among patients with RAAAs. Clearly, all patients with an RAAA were sufficiently hemodynamically stable so that a CT scan could be obtained in each case, which is atypical. Indeed, it is noted that there was a 76-minute delay between obtaining the CT scan and getting the patient to the operating room for surgery. They do not tell us how much time elapsed from the initial examination to getting to the CT scanner or if some of these patients were actually transferred to Northwestern University from other facilities.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature
Abdominal Aortic Aneurysm

The Rational Clinical Examination
Make the Diagnosis: Abdominal Aortic Aneurysm

brightcove.createExperiences();