J: Abdominal aortic aneurysm. A reappraisal. Circulation

PRIOR to the advent of successful recon-structive aortic surgery, abdominal aortic aneurysm was a condition for which there was no effective therapy. A review of a series of such cases by Estes,1 in 1950, was the first adequate attempt at delineating the natural history of this disease. Since that time, ex-cision of aneurysms with replacement by homografts and, more recently, by synthetic materials has become widespread. Opinion concerning the selection of patients for sur-gical repair of aneurysms has varied; some authors2 ' 3 have stated that the presence of an abdominal aortic aneurysm is a clear indi-cation for repair; others4 have recommended a more conservative attitude toward this problem. A study of the records of a large group of untreated patients with abdominal aortic aneurysm seen during a period when vascular surgery was available should provide a guide to the proper selection of patients for aneu-rysmal excision.5 The records of 141 patients with abdominal aortic aneurysms seen at the Mayo Clinic in the 10 years between January 1, 1950, and January 1, 1960, therefore, were reviewed. Each of these patients either had elected to defer excision of the aneurysm or else were not offered surgery when they were first seen. The reeords were selected for study only after it was clear that the diagnosis had been established by adequate objective evi-dence of an aneurysm. Such evidence included the presence of a pulsating, expansile, intra-abdominal mass in the region of the abdom-inal aorta, roentgenographic calcific shadows compatible with the diagnosis of abdomina