Repair of Small Abdominal Aortic Aneurysms
http://www.100md.com
《新英格兰医药杂志》
To the Editor: The recently issued guidelines of the American College of Cardiology and the American Heart Association (ACC–AHA) for the care of patients with peripheral arterial disease include the following recommendation regarding abdominal aortic aneurysms: "Repair can be beneficial in patients with infrarenal or juxtarenal 5.0 to 5.4 cm in diameter."1 The document then describes two randomized trials, conducted by us and published together in the Journal,2,3 that compared repair with surveillance for abdominal aortic aneurysms 4.0 to 5.4 cm in diameter. Both trials reported no benefit from repair of abdominal aortic aneurysms less than 5.5 cm in diameter or in any subgroup of patients defined by aneurysm diameter at entry, a finding that directly refutes the ACC–AHA recommendation, for which no alternative justification is presented. The issuance of guidelines is an opportunity to disseminate and implement information that has been obtained at great cost and effort. It is unfortunate when such recommendations misrepresent that information.
Frank A. Lederle, M.D.
Veterans Affairs Medical Center
Minneapolis, MN 55417
frank.lederle@va.gov
Janet T. Powell, M.D., Ph.D.
Roger M. Greenhalgh, M.D.
Imperial College London
London W68RP, United Kingdom
References
Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary. J Am Coll Cardiol 2006;47:1239-1312.
Lederle FA, Wilson SE, Johnson GR, et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 2002;346:1437-1444.
The United Kingdom Small Aneurysm Trial Participants. Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 2002;346:1445-1452.
Frank A. Lederle, M.D.
Veterans Affairs Medical Center
Minneapolis, MN 55417
frank.lederle@va.gov
Janet T. Powell, M.D., Ph.D.
Roger M. Greenhalgh, M.D.
Imperial College London
London W68RP, United Kingdom
References
Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary. J Am Coll Cardiol 2006;47:1239-1312.
Lederle FA, Wilson SE, Johnson GR, et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 2002;346:1437-1444.
The United Kingdom Small Aneurysm Trial Participants. Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 2002;346:1445-1452.