We discussed EVAR (Endovascular Aneurysm Repair). A NEJM review can be found here. The precise role for EVAR (rather than open) repair is still debated. 2005 AHA guidleines suggest EVAR of infrarenal AAA could be considered in patients at high risk of complications following open repair and may be considered in those at low or average surgical risk. Longterm monitoring, including imaging, should be performed to ensure late complications do not develop. Several studies have been published since then and EVAR is being more widely used.
We also briefly discussed multiple myeloma. A review in BLOOD was published in 2008. Treatment in this field has evolved rapidly over recent years.
Finally, we discussed the physical exam diagnosis of aortic stenosis. The findings of a paper examining a clinical prediction rule for AS is summarized in the following figure from the article.
Abscence of a murmur over the right clavicle (see article Table 1 for how to auscultate for this) as performend by a staff internist or senior medical resident, effectively rules out moderate to severe AS (usually more important clinically than ruling in AS, as to rule it in a TTE will often be performed).
The JAMA rational clinical exam "Does this patient have an abnormal systolic murmur?" can be found here.
