The literature on arterial aneurysms is subject to potential misinterpretation because of inconsistencies in reporting standards. The joint councils of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery appointed an ad hoc committee to address this issue. This communication, prepared in response to the need for standardized reporting, defines and classifies arterial aneurysms and recommends standards for describing the causes, manifestations, treatment, and outcome criteria that are important when publishing data on aneurysmal disease.

Endovascular repair of TAA has shown a promising reduction in operative morbidity; however, the risk of spinal cord ischemia remains. Concomitant or previous abdominal aortic aneurysm repair and long segment thoracic aortic exclusion appear to be important risk factors. Spinal cord protective measures (ie, cerebrospinal fluid drainage, steroids, prevention of hypotension) should be used for patients with the aforementioned risk factors undergoing endovascular TAA repair.

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Fibromuscular dysplasia is a nonatherosclerotic, noninflammatory vascular disease that involves primarily the renal and internal carotid arteries and less often the vertebral, iliac, subclavian, and visceral arteries. Although its pathogenesis is not completely understood, humoral, mechanical, and genetic factors as well as mural ischemia may play a role. The natural history is relatively benign, with progression occurring in only a minority of the patients. Typical clinical manifestations are renovascular hypertension, stroke, subarachnoid hemorrhage, abdominal angina, or claudication of the legs or arms. In patients with symptoms, percutaneous transluminal angioplasty has emerged as the treatment of choice in most involved vascular beds.

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Almost 75% of carotid body and cervical paragangliomas are adherent to or surround adjacent arteries and cranial nerves. Their resection can result in neurovascular injury, stroke, and excessive blood loss. To assess trends in neurovascular complications, we reviewed 153 carotid body and cervical paragangliomas that were surgically managed between 1935 and 1985. Results of the past 10 years were compared with two previous time periods: period I (1935 to 1965), when carotid artery reconstruction was uncommon at our institution, and period II (1966 to 1975), when methods of intraoperative electroencephalographic monitoring and carotid patch angioplasty were being developed. During the past 10 years (period III), surgical approach to these tumors has included intraoperative monitoring of cerebral blood flow, selective use of shunts, vein patch or graft reconstructions after extensive tumor resections, and mobilization of the parotid gland to facilitate adequate exposure of high tumors. Although tumor resection was attempted in 80% of patients in period I, surgical resection was complete in 98% during periods II and III. Three trends were observed: (1) The perioperative stroke rate has decreased dramatically from 23% in period I to 2.7% in period III (p = 0.007); (2) the perioperative mortality rate has been reduced from 6% in period I to no deaths in the past 10 years, but (3) the rate of postoperative cranial nerve dysfunction remains unchanged over 50 years (period I, 46%; period III, 40%). The median tumor size among patients with postoperative complications was significantly larger than those without complications (median size: 17 vs. 7 cm3, p = 0.004).(ABSTRACT TRUNCATED AT 250 WORDS)

Endovascular extension grafts, coil embolization, and conversion to open surgery each may be used to effectively repair endoleak. Selection of the treatment method used is determined by the anatomic characteristics of the endoleak and the patient's ability to tolerate conventional repair. Conversion to open repair was uniformly successful. Deployment of an extension cuff was successful when complete closure of the endoleak was achieved. Embolic coils were effective for retrograde endoleaks and provided stabilization of AAA size in selected patients with attachment site endoleaks in limited follow-up.

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