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Intraluminal Grafts: Historical Perspectives

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Peripheral Endovascular Interventions

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Abstract

Abdominal aortic aneurysms (AAAs) are the thirteenth leading cause of death in the United States, and their incidence is increasing.1 A Mayo Clinic study showed an overall incidence of 36.5 per 100,000 people per year with a sevenfold increase from 1951 to 1980. This increase only partially reflects improved diagnostic capabilities because it is also due to the increased aging of the population.2 The final endpoint of an untreated AAA is its rupture, but this event is difficult to predict. Although the most important predictor of rupture is size, even small aneurysms rupture. Darling found that the risk of rupture is 9.5% for AAAs less than 4cm in diameter and 23.4% for those between 4 and 5 cm.3 It has been calculated that, if hypertension is present, the risk of rupture is 20% for 4-cm AAAs.4 Even the expansion rate of an aneurysm is difficult to predict because, although the average expansion rate is 0.5 cm per year, great variability has been found in the rate at which individual aneurysms expand.5 When an aneurysm ruptures, the total mortality is in the order of 78% to 94%, with 27% to 50% of patients dying before reaching the hospital, 24% to 58% dying in the hospital before the operation, and 42% to 80% in the postoperative period.6 These considerations have suggested that the mere presence of an aneurysm should be regarded as an indication for surgery in low-risk patients. However, although some centers claim a mortality rate of about 2% for elective aneurysm repair, the average operative mortality varies between 4% and 11%, with peaks of 60% in older patients with coronary heart disease, chronic pulmonary insufficiency, or renal failure.7 In any case, conventional surgical treatment causes significant debility. It requires a large abdominal incision and extensive abdominal dissection, which induce postoperative respiratory impairment and prolonged ileus. The physiologic derangements caused by aortic clamping and declamping may precipitate cardiovascular instability with consequent myocardial ischemia, stroke, or kidney failure. In addition, the need to open the aorta and to suture a graft potentiates intraoperative or postoperative bleeding, which might necessitate giving blood transfusions. This introduces further risks. Dissection of the autonomic plexus around the aortic bifurcation may cause postoperative impotence. Also, the uncomplicated postoperative course requires at least 24 hours in an intensive care unit and averages 10 days in the hospital; high-risk patients clearly require longer hospital stays with considerable increase in the total hospital costs.8

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Authors
  1. Marco Scoccianti
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  2. Rodney A. White
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Editors and Affiliations

  1. Division of Vascular Surgery, Harbor-UCLA Medical Center, 90509, Torrance, California, USA

    Rodney A. White MD (Chief. Professor of Surgery) (Chief. Professor of Surgery)

  2. UCLA School of Medicine, 90095, Los Angeles, California, USA

    Rodney A. White MD (Chief. Professor of Surgery) (Chief. Professor of Surgery)

  3. Stanford University Medical Center, 90509, Stanford, California, USA

    Thomas J. Fogarty MD (Professor of Surgery) (Professor of Surgery)

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© 1999 Springer Science+Business Media New York

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Scoccianti, M., White, R.A. (1999). Intraluminal Grafts: Historical Perspectives. In: White, R.A., Fogarty, T.J. (eds) Peripheral Endovascular Interventions. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-3105-7_23

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  • DOI: https://doi.org/10.1007/978-1-4757-3105-7_23

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4757-3107-1

  • Online ISBN: 978-1-4757-3105-7

  • eBook Packages: Springer Book Archive

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