The IAAs followed up by this contemporary Veterans Affairs vascular surgery service were small, rarely caused symptoms or rupture, and expanded at a slow rate. IAAs smaller than 3 cm could be followed up safely on an annual basis with B mode ultrasound scanning. IAAs that are 3 cm or larger and smaller than 3.5 cm should be carefully followed with B mode ultrasound scanning at 6-month intervals, whereas elective repair should be considered for IAAs 3.5 cm or larger in good-risk patients. Based on this report and currently available evidence and recommendations, asymptomatic IAAs that are 4 cm or larger and all other symptomatic IAAs should be considered for operative repair. Also, the reported high rupture rate of IAAs that are 5 cm or larger mandates prompt operative repair.

AAAs of 3.0 cm to 3.9 cm expanded slowly, did not rupture, and rarely had operative repair or expanded to more than 5.0 cm in our study of male patients. Expansion rates and the incidence rate of operative repair are more common in the 3.5-cm to 3.9-cm AAA when compared with the 3.0-cm to 3.4-cm AAA.

Among patients with coronary artery disease who undergo vascular surgery, a peri-operative elevation in cardiac troponin levels is common and in combination with diabetes, is a strong predictor of long-term mortality. These data support the utility of cardiac troponins as a means of stratifying high-risk patients following vascular operations.

Intimal hyperplasia, common at the deployment site of an intra-arterial stent, may be caused by artery wall hypoxia. The purpose of this study was to determine the effect of an intra-arterial stent on artery wall oxygen concentrations. Transarterial wall oxygen gradients were measured by microelectrode at stent deployment sites in New Zealand White rabbits. Thinned artery walls and decreased oxygen tensions were noted throughout the artery wall immediately following stent deployment with a return toward control values at 28 days. Angioplasty alone had no acute effect on artery wall oxygen concentrations. Larger stent deployment diameters yielded acutely lower artery wall oxygen tensions. Using a linear one-dimensional model for the oxygen profile, we noted that stent deployment resulted in acute changes in oxygen consumption in the inner artery wall that rapidly returned to control values. Changes were noted without differences in blood pressure or arterial blood oxygen concentrations. Oxygen delivery to and consumption within the artery wall are altered by intra-arterial stent deployment. A role for artery wall hypoxia in artery wall pathology at the deployment site of an intra-arterial stent is supported by these findings.