On a national level, over the past 19 years, our ability to identify and to treat patients with AAA has not improved. Advances in technology and critical care have not affected outcome. Regionalization of care, screening of high-risk populations, and endovascular repair are strategies that might allow further improvement in the outcome of patients with aneurysmal disease.
Interventions for vascular disease have increased dramatically, with a major shift toward less invasive treatments, particularly for the renal and mesenteric vessels and the lower extremities. These trends in procedural use suggest that vascular surgeons need to embrace catheter-based approaches if they want to remain leaders in the treatment of peripheral vascular diseases.
We observed a benefit to using endovascular procedures for RAAAs in institutions with significant endovascular experience; however, the analysis of administrative data cannot rule out selection bias as an explanation of better outcomes. These data strongly endorse the need for prospective studies to clarify to what extent the improved survival in RAAA patients is to be attributed to the endovascular approach rather than the selection of low-risk patients.
Although the rate of surgery for cervical disc disease did not increase significantly during the 1990s, the rate of fusion procedures did rise significantly.
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