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- W2023854775 abstract "We read with keen interest the article by Palm et al (J Vasc Surg 2000;32:179-200) regarding the acute enlargement and rupture of an abdominal aortic aneurysm in a patient receiving chemotherapy for stage IV pancreatic carcinoma. A life expectancy of less than 2 years is considered a relative contraindication to repair of a an abdominal aortic aneurysm.1Mohan IV Harris PL When not to operate for abdominal aortic aneurysms.Semin Interv Cardiol. 2000; 5: 15-19PubMed Google Scholar The clinicians wisely decided not to repair the abdominal aortic aneurysm at the initial operation since the patient was also found to have incurable stage IV pancreatic carcinoma, which carries a median survival of less than 6 months.2Sarr MG Cameron JL Surgical management of unresectable carcinoma of the pancreas.Surgery. 1982; 91: 123-133PubMed Google Scholar Even when resection is possible, the survival is less than 1 year.3Taschieri AM Elli M Rovati M Sampietro GM Cristaldi M Danelli P et al.Surgical treatment of pancreatic tumors invading the spleno-mesenteric-portal vessels: an Italian Multicenter Survey.Hepatogastroenterology. 1999; 46: 492-497PubMed Google Scholar Moreover, patients with limited life expectancy usually die of their other medical problems rather than rupture.4Jones A Cahill D Gardham R Outcome in patients with a large abdominal aortic aneurysm considered unfit for surgery.Br J Surg. 1998; 85: 1382-1384Crossref PubMed Scopus (64) Google Scholar Thus, nonoperative management was medically and ethically sound. The authors did not tell us why they allowed the aneurysm to grow to 7.1 cm and rupture before performing an emergent aneurysmorrhaphy. Certainly, the patient was an even worse candidate for surgical intervention at the time of his rupture than perhaps at his initial surgical exploration in January 1998. Perhaps the authors could explain to us their discussions with this patient and his family regarding death and dying. The resolution of such end-of-life issues may be more important than any surgical treatment that could be offered.5Field D Copp G Communication and awareness about dying in the 1990s.Palliat Med. 1999; 13 (Review): 459-468Crossref PubMed Scopus (80) Google Scholar 24/41/113300" @default.
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- W2023854775 date "2001-03-01" @default.
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- W2023854775 title "Regarding “Acute enlargement and subsequent rupture of an abdominal aortic aneurysm in a patient receiving chemotherapy for pancreatic carcinoma”" @default.
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- W2023854775 doi "https://doi.org/10.1067/mva.2001.113300" @default.
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