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(Circulation. 2004;109:2643-2650.)
© 2004 American Heart Association, Inc.

AHA Conference Proceedings

Atherosclerotic Vascular Disease Conference

Writing Group VI: Revascularization

Michael A. Bettmann, MD, Chair; Michael D. Dake, MD; L. Nelson Hopkins, MD; Barry T. Katzen, MD; Christopher J. White, MD; Andrew C. Eisenhauer, MD; William H. Pearce, MD; Kenneth A. Rosenfield, MD; Richard W. Smalling, MD, PhD; Thomas A. Sos, MD; Anthony C. Venbrux, MD

Key Words: AHA Conference Proceedings • revascularization • aorta • atherosclerosis • catheter

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Revascularization has changed dramatically over the last 2 decades, with the use of percutaneous interventional techniques both replacing much of what was done with open surgery and increasing the number of patients with noncoronary atherosclerotic disease who are treated. Despite major advances, many questions remain, partly because of the continuing evolution of tools and techniques and partly because of the paucity of large prospective randomized trials. This section reviews recent advances, addresses areas of concern, and focuses primarily on the current status of catheter-based vascular interventions for atherosclerotic vascular diseases.

Aortic Diseases

Thoracic disease and abdominal aortic disease are distinct yet related disorders. In the context of this discussion, vascular intervention is relevant to thoracic aortic aneurysms (TAAs), dissection and trauma, and abdominal aortic aneurysms (AAAs). Revascularization of aortic occlusive disease is discussed later in conjunction with peripheral artery revascularization.

AAAs are far more common than TAAs. The reported incidence depends on the method of surveillance and the specific population, but it is estimated that 5% of men >65 years of age have small, asymptomatic AAAs. The incidence is greater in men than women, and >90% of persons with AAA have a long history of tobacco abuse.¹ A more detailed discussion of the etiology and natural history of AAAs is provided elsewhere in this document. The risk of rupture is minimal for aneurysms with a diameter <4 cm. Conversely, for aneurysms >6 cm in diameter, the annual rupture risk is >25%.² A rapid increase in size is the best predictor of rupture . . . [Full Text of this Article]