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AAA and WHO/SVS criteria

University Hospital Sestre Milosrdnice, Zagreb 1000, Croatia

Complications of open abdominal aortic surgery: the endovascular solution

Since 1990s we have used the WHO criteria (disease should be an important health problem; a generally acceptable method of treatment must be available; the policy of treatment must be clear; provision for diagnosis must be available; the disease must have a detectable latent stage; a suitable screening method must be available; the screening method must be accepted by the target population; the natural course of the disease must be known; the program must be cost-effective; the treatment of the disease should favour the prognosis of the patients) to analyze AAA from a screening perspective [1].

The reporting guidelines identify and define several aspects that are to be considered when reporting outcomes related to EVAR as well as for the comparison of complications of EVAR and OSR. They are classified by factors contributing to the composite outcome measure to evaluate EVAR, as defined by the Society for Vascular Surgery/American Association for Vascular Surgery [SVS/AAVS]. They are classified by factors contributing to the composite outcome measure to evaluate EVAR, as defined by the SVS guidelines as primary technical success rate [PTSR]. After PTSR, technical success is the other major endpoint used to evaluate OSR/EVAR. Another endpoint to evaluate OSR/EVAR is clinical success in the perioperative period. Management options are primarily based on pateint's life expectancy and AAA size and include no treatment, active surveillance and delayed repair, immediate OSR, and/or EVAR.

Yet there is a debate on how contemporary knowledge about AAA stands in relation to the WHO criteria, and to address critical areas where the knowledge is still insufficient. In the article by Sakka et al. [2], the authors cover almost all criteria, except one. This one is the conclusion that the follow-up studies must give more information on pathophysiological processes.

For the purpose of fulfilling the WHO/SVS/AAVS criteria, it could be wise to keep in mind the fact that despite the technical feasibility of inserting prosthesis into the AAA, sufficient sealing is not always achieved. A leading mechanism is most likely that radial forces and severely curved pathways of vessels, combined with constant friction between the prosthesis skeleton, are more pronounced within the suture lines. Elongation and constriction in the longitudinal axis due to functional alterations during daily life may also contribute to this process.

It remains to be seen if new generations of prosthesis will perform better with regard to graft-associated complications such as aorto-enteric fistulas (AEFs), and para-anastomotic aneurysms (PAAs).

	References

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1. Bergqvist D, Bengtsson H. Should screening for abdominal aortc aneurysms be advocated? Acta Chir Scand 1990; 555:89–97.
2. El Sakka KE, Halawa M, Kotze C, Francis C, Doyle T, Yusuf W. Complications of open abdominal aortic surgery: the endovascular solution. Interact CardioVasc Thorac Surg 2008; 7:121–125.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Narcis Hudorovic Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hudorovic, N. Search for Related Content PubMed Articles by Hudorovic, N. Related Collections Related Article