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Expanding and Ruptured Abdominal Aortic Aneurysms: Problems of Diagnosis and Treatment

Expanding and Ruptured Abdominal Aortic Aneurysms: Problems of Diagnosis and Treatment Abstract "In the last analysis, apart from wiring the aneurysm and carrying out the general regime of rest and peace, but little can be done. The patient, however, should not be discouraged, as it is surprising how long he may live in comparative comfort, and the possibility of sudden exit from rupture should never be mentioned." This summary of the treatment of abdominal aortic aneurysms in a fine and popular textbook of internal medicine1 10 years ago was an accurate assessment of the help that the physician could offer to the patient with an abdominal aortic aneurysm, and although it seems modest enough, it actually grossly overestimated the value of wiring and was entirely too optimistic about the patient's chances of survival. It must be put down as one of the impressive achievements of medical progress during the past decade that this quotation has become obsolete and that the effective References 1. The term "expanding aneurysm" is used in this discussion to denote an aneurysm with symptoms but without rupture. The adjectives "leaking" and "symptomatic" have often been linked with the name of such aneurysms, but the former is inaccurate, the latter too vague. 2. The term "leaking aneurysm," when not used loosely to denote any aneurysm with symptoms but without clinically obvious rupture, refers, in common parlance, to this type of aneurysm. 3. A brief comment on the semantics of the recording of operative results in the treatment of abdominal aortic aneurysms with rupture would not be out of place here. An abdominal aortic aneurysm that has ruptured is an invariably and swiftly fatal lesion. It may perhaps happen that a small rupture is so completely sealed off that survival of the patient is possible for some length of time, but in our experience this event has never been observed, and it undoubtedly has a negligible probability. Properly speaking, therefore, the results of operations for the treatment of ruptured abdominal aortic aneurysms should be expressed in terms of rates of salvage, rather than rates of mortality. Since, however, using salvage rates in the tables of operative results would be both too radically novel and liable to misinterpretation, we shall follow the conventional way of recording the results. Nevertheless, the rates of operative mortality and postoperative survival ought always to be read with the understanding that in fact they represent the rate of failure or success of salvage from certain fatality. 4. Meakins, J. C.: The Practice of Medicine , Ed. 5, St. Louis, C. V. Mosby Company, 1950, p. 442. 5. Cooley, D. A., and DeBakey, M. E.: Ruptured Aneurysms of the Abdominal Aorta: Excision and Homograft Replacement , Postgrad. Med. 16:334-342 ( (Oct.) ) 1954. 6. Loewenthal, J.; Milton, G. W., and Shead, G. V.: Differential Diagnosis of Leaking Retroperitoneal Aneurysm , Med. J. Aust. 2:137-41 ( (Aug. 1) ) 1959. 7. Elliott, J. A.; McKenzie, A. D., and Chung, W. B.: Ruptured Abdominal Aortic Aneurysm , Surgery 46:605-17 ( (Sept.) ) 1959. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Expanding and Ruptured Abdominal Aortic Aneurysms: Problems of Diagnosis and Treatment

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References (4)

Publisher
American Medical Association
Copyright
Copyright © 1961 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1961.01300150069009
Publisher site
See Article on Publisher Site

Abstract

Abstract "In the last analysis, apart from wiring the aneurysm and carrying out the general regime of rest and peace, but little can be done. The patient, however, should not be discouraged, as it is surprising how long he may live in comparative comfort, and the possibility of sudden exit from rupture should never be mentioned." This summary of the treatment of abdominal aortic aneurysms in a fine and popular textbook of internal medicine1 10 years ago was an accurate assessment of the help that the physician could offer to the patient with an abdominal aortic aneurysm, and although it seems modest enough, it actually grossly overestimated the value of wiring and was entirely too optimistic about the patient's chances of survival. It must be put down as one of the impressive achievements of medical progress during the past decade that this quotation has become obsolete and that the effective References 1. The term "expanding aneurysm" is used in this discussion to denote an aneurysm with symptoms but without rupture. The adjectives "leaking" and "symptomatic" have often been linked with the name of such aneurysms, but the former is inaccurate, the latter too vague. 2. The term "leaking aneurysm," when not used loosely to denote any aneurysm with symptoms but without clinically obvious rupture, refers, in common parlance, to this type of aneurysm. 3. A brief comment on the semantics of the recording of operative results in the treatment of abdominal aortic aneurysms with rupture would not be out of place here. An abdominal aortic aneurysm that has ruptured is an invariably and swiftly fatal lesion. It may perhaps happen that a small rupture is so completely sealed off that survival of the patient is possible for some length of time, but in our experience this event has never been observed, and it undoubtedly has a negligible probability. Properly speaking, therefore, the results of operations for the treatment of ruptured abdominal aortic aneurysms should be expressed in terms of rates of salvage, rather than rates of mortality. Since, however, using salvage rates in the tables of operative results would be both too radically novel and liable to misinterpretation, we shall follow the conventional way of recording the results. Nevertheless, the rates of operative mortality and postoperative survival ought always to be read with the understanding that in fact they represent the rate of failure or success of salvage from certain fatality. 4. Meakins, J. C.: The Practice of Medicine , Ed. 5, St. Louis, C. V. Mosby Company, 1950, p. 442. 5. Cooley, D. A., and DeBakey, M. E.: Ruptured Aneurysms of the Abdominal Aorta: Excision and Homograft Replacement , Postgrad. Med. 16:334-342 ( (Oct.) ) 1954. 6. Loewenthal, J.; Milton, G. W., and Shead, G. V.: Differential Diagnosis of Leaking Retroperitoneal Aneurysm , Med. J. Aust. 2:137-41 ( (Aug. 1) ) 1959. 7. Elliott, J. A.; McKenzie, A. D., and Chung, W. B.: Ruptured Abdominal Aortic Aneurysm , Surgery 46:605-17 ( (Sept.) ) 1959.

Journal

Archives of SurgeryAmerican Medical Association

Published: Sep 1, 1961

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