ABSTRACT
The management of any asymptomatic condition, such as abdominal aortic aneurysm, carotid artery stenosis (CAS), valvular heart disease, or even coronary artery disease, with surgical or even an endovascular procedure in an attempt to prevent the possibility of a future, potentially catastrophic, event can be a difficult undertaking for both patients and physicians alike. Specific factors considered during the consultation with the patient should include risks of the natural history of the condition, and alternatively the risks of the operation, procedure, or medication. Add to these relatively quantifiable factors certain, less objective, features such as the life expectancy of the patient and the patient’s tolerance for ‘active’ (intervention) vs ‘passive’ (natural history) risk taking. A further complicating feature is
the assignment of an individual patient’s risk from population data. As an example, the per year risk of aneurysm rupture for any given diameter size is reasonably known for a population, but interpolating these data to the individual patient becomes problematic. Many of the evidence-based data may be in populations which are not identical in some, if not many, factors, such as age, medical comorbidities, etc., of the patient the physician is trying to counsel, thus confounding the physician’s attempts to give accurate assessments of each side of the equation.
