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D. Craig Miller, MD
Stanford University School of Medicine Stanford, Calif

JAMA. 1979;241(16):1685-1686.

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The plangent commentary by Dr Fisch that pertains to our essay concerning the lack of prospective, randomized, and controlled clinical studies on the efficacy of peripheral vascular reconstructive surgery is timely and commendable. Dr Fisch excludes surgery for abdominal aortic aneurysm from his comments, based on the belief that the "dismal course of the untreated disease appears to be well documented." The efficacy of surgical treatment of abdominal aortic aneurysms, however, is assumed only by inference from natural history studies. To my knowledge, no controlled, prospective clinical studies on this subject have been performed. This is also true for most other peripheral vascular surgical procedures, with the exception of carotid endarterectomy stenosis. It is unlikely that such will be carried out in the future, principally because of the heterogeneity of the disease process (atherosclerosis), which precludes strict stratification of patients and accurate indexing of most patient-related variables, excluding . . . [Full Text PDF of this Article]

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