Endovascular repair compared with surveillance for patients with small abdominal aortic aneurysms

Division of Vascular Surgery, Columbia University and NewYork-Presbyterian Hospital, New York, NY, USA.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter (Impact Factor: 3.02). 03/2010; 51(5):1081-7. DOI: 10.1016/j.jvs.2009.10.113
Source: PubMed


Although repair of large abdominal aortic aneurysms (AAAs) is well accepted, randomized clinical trials have failed to demonstrate benefit for early surgical repair of small aneurysms compared with surveillance. Endovascular repair has been shown to be safer than open surgical repair in patients with large aneurysms, prompting a randomized trial of early endovascular repair vs surveillance in patients with small aneurysms.
We randomly assigned 728 patients (13.3% women; mean age, 71 +/- 8 years) with 4 to 5 cm AAAs to early endovascular repair (366 patients) or ultrasound surveillance (362 patients). Rupture or aneurysm-related death and overall mortality in the two groups were compared during a mean follow-up of 20 +/- 12 months.
Among patients randomized to treatment, 89% underwent aneurysm repair. Among patients randomized to surveillance, 31% underwent aneurysm repair during the course of the study. After a mean follow-up of 20 +/- 12 months (range, 0-41 months), 15 deaths had occurred in each group (4.1%). The unadjusted hazard ratio (95% confidence interval) for mortality after early endovascular repair was 1.01 (0.49-2.07, P = .98). Aneurysm rupture or aneurysm-related death occurred in two patients in each group (0.6%). The unadjusted hazard ratio was 0.99 (0.14-7.06, P = .99) for early endovascular repair.
Early treatment with endovascular repair and rigorous surveillance with selective aneurysm treatment as indicated both appear to be safe alternatives for patients with small AAAs, protecting the patient from rupture or aneurysm-related death for at least 3 years.

Full-text preview

Available from:
  • [Show abstract] [Hide abstract]
    ABSTRACT: A six-mask process that provides joint-gate CMOS structures with the source and drain of both transistors self-aligned to the joint-gate electrode has been developed. The features that permit the full self-alignment are an edge-defined silicon nitride "filament" (used as an oxidation mask) and overlapping polysilicon "handles" used to form the top transistor source and drain regions. The structures have been characterized as individual nMOS and pMOS transistors and are functional as joint-gate CMOS inverters.
    No preview · Conference Paper · Feb 1983
  • [Show abstract] [Hide abstract]
    ABSTRACT: A tool that provides a generic interface window to help users to construct new window types or modify existing window types (e.g. add subviews or extend their functionalities) is presented. The interface window allows the users to specify the configuration and the attributes of a window interactively and permits users to test its functionality by manipulating it directly. It relieves the users from the burden of thinking about the windowing details at the construction or modification of a window. It further encourages the exploration of more design alternatives for windows so that users can prototype and evaluate various window configurations easily to determine the one that will be adapted into the application. With this tool, the construction of new window types and the modification of existing window types become easy and flexible. The windows evolved in such a programming environment can thus be experimented with and tailored to suit the needs of the user
    No preview · Conference Paper · Oct 1989
  • [Show abstract] [Hide abstract]
    ABSTRACT: We investigate the possibility of having an input-output model that has a specific structure for multivariable input-output linearizable systems
    No preview · Article · Jan 1997
Show more