Special Article
Suggested standards for reporting on arterial aneurysms☆

https://doi.org/10.1067/mva.1991.26737Get rights and content

Abstract

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. (J VASC SURG 1991;13:444-50.)

Section snippets

Definitions

The following definition of an arterial aneurysm is suggested: An aneurysm is a permanent localized (i.e., focal) dilation of an artery having at least a 50% increase in diameter compared to the expected normal diameter of the artery in question. In this regard normal arterial diameters determined from selected data in the literature should be considered when reporting on aneurysms (Table I).

. Representative diameters of normal adult arteries

VesselRange of reported mean (cm)Range of reported

Classification

No classification of arterial aneurysms based on a single factor has proved to be entirely satisfactory. It is therefore recommended that aneurysms be classified with a combination of the following factors: (1) site, (2) origin, (3) histologic features, and (4) clinicopathologic manifestations. In any one specific report it may be appropriate to select only one of these factors as the basis for classification.

Anatomic definition (diagnostic tests)

Accurate description of the maximum external transverse or anteroposterior diameters, extent, and sites of arterial aneurysmal involvement are important for the proper interpretation of natural history studies or reports on the treatment of aneurysms.

In some reports physical examination alone may provide adequate documentation, especially for peripheral aneurysms. Measurements from plain roentgenograms, when corrected for magnification, may be used to report the maximum diameter of an aneurysm

Additional relevant factors in patients with aneurysms

Family history of aneurysmal disease is a significant risk factor for the development of abdominal aortic aneurysms and details on at least each first degree relative (i.e., mother, father, siblings, and children) should be recorded in reports regarding cause.

Certain other factors should also be reported since they may be associated with the development of aneurysms including factors such as age, sex, race, hypertension, chronic obstructive lung disease, malignancy, number of pregnancies,

Details of operation

To interpret surgical results a detailed description of the operative procedure is necessary. It is important to note whether the operation was performed on an emergent, urgent, or elective basis. Emergent procedures are undertaken as soon as possible (i.e., within 4 hours) because of an immediate threat to life or organ. Urgent procedures are performed with a minimum of preoperative preparation (i.e., within 24 to 36 hours). Elective procedures are performed at the convenience of both the

Perioperative management

The details of the perioperative management may be important in certain reports on the results of operations for aneurysms, and should be detailed in reports on outcome (Table VII).

. Details of perioperative care (especially for aortic aneurysm repair)

Vital signs, monitoring methodology
Renal function
Antibiotics: type, duration
Cardiac, vascular drugs: type, duration
Renal drugs: type, duration
Anticoagulants: type, systemic or regional, duration
Blood loss, blood replacement
Crystalloid administration

Outcome assessment

Ideally, the results of surgical treatment for aneurysms should be compared to the natural history of the aneurysmal disease. Unfortunately, reliable information on the latter is lacking for most arterial aneurysms. Hence, in descriptive outcome studies success should be defined by means of the following criteria: patient survival, patency of the arterial reconstruction, and the absence of significant vascular or nonvascular complications.

Mortality—survival

Both early and late mortality rates should be reported. Death from any cause within the first 30 postoperative days is considered to have been caused by the effects of the surgical procedure, an early (perioperative) death. Early deaths may be related to factors such as the severity of vascular disease, coexisting systemic diseases, and the quality of the medical care including precision of diagnosis, judgment regarding surgical intervention, operative technique, and perioperative nonsurgical

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    Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter. Published by Mosby, Inc. All rights reserved.