To the Editor: Dr Lederle and colleagues1 conducted a randomized trial to compare endovascular vs open repair of AAA, showing lower perioperative mortality for endovascular repair. The early advantage of endovascular repair was not offset by increased mortality in the first 2 years after repair.
The atherosclerotic process is often not limited to a single arterial location, giving it a character of a systemic and generalized disease. More than 25 years ago, a study by Hertzer et al2 demonstrated that only 6% of patients with an AAA have a healthy coronary tree. In a study by Feringa et al,3 a group of patients who had vascular surgery and underwent preoperative cardiac testing had an asymptomatic ejection fraction of less than 40% or silent ischemia (new wall motion abnormalities) in 14% and 41% of the patients, respectively.
van Kuijk J, Flu W, Poldermans D. Comparing Endovascular and Open Repair of Abdominal Aortic Aneurysm. JAMA. 2010;303(6):513-514. doi:10.1001/jama.2010.87