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To the Editor:—
The message that I get from the report of Friedman et al (200:1147, 1967) is that abdominal aortic aneurysms should be excised when detected. Nevertheless, of 100 consecutive patients who had such operations in their institution, 4 died and another 24 had serious postoperative complications. The crux is to know what would have happened to these 100 patients had they not been operated upon. For this, a well-controlled, properly designed, prospective study of patients with abdominal aneurysms divided into separate categories and followed up for appropriate periods of time is necessary. Until such data are available, the argument that small abdominal aneurysms in patients with associated cardiovascular disease may be treated by careful observation (Circulation26:200, 1962) is as tenable as that which suggests that all aneurysms should be removed. Unfortunately, both statements are really guesswork.
Schatz IJ. Treatment of Abdominal Aortic Aneurysms. JAMA. 1967;201(8):641. doi:10.1001/jama.1967.03130080083034
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