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Abdominal Aortic Aneurysm: Preoperative Evaluation-Reply

Mark T. Mikinski, MD; Marvin I. Dunn, MD
JAMA. 1993;270(11):1318-1319. doi:10.1001/jama.1993.03510110054026.
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In Reply.  —We greatly appreciate the comments of Drs Loo, Fisher, Castro, and Byrne and wholeheartedly agree that patients should be fully informed about the potential risks and benefits of any planned procedure. There are, however, several points in their statement that must be clarified.The original question and our answer dealt with the preoperative evaluation of patients scheduled for elective (AAA) repair. Our preoperative risk assessment strategy was specifically targeted at this group of patients and was not intended to be used as a general preoperative guideline for all forms of noncardiac vascular surgery. In patients with an AAA, clinical risk factors are age greater than 70 years, diabetes mellitus, angina, abnormal Q-waves on electrocardiogram, and ventricular ectopy. The patients who have three or more of these factors are at high risk of having a postoperative cardiac event with an event rate of 25% as we stated. Patients with


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