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Rupture Risk of Large Abdominal Aortic Aneurysms: A Scoping Review
Jitse H M Paping1, Ruth M A Bulder1, Elizabeth Lancaster2
1Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Annals of Vascular Surgery
|November 2, 2025
Summary
The rupture risk of abdominal aortic aneurysms (AAAs) larger than 55 mm may be lower than previously thought. Most studies overestimate rupture risk by not accounting for competing risks, except for one large, recent study.
Area of Science:
- Vascular Surgery
- Medical Statistics
- Epidemiology
Background:
- Current abdominal aortic aneurysm (AAA) management relies on a 55 mm intervention threshold.
- This threshold may be overly conservative, with ongoing debate regarding the rupture risk of AAAs exceeding 55 mm.
Purpose of the Study:
- To critically review and summarize evidence on the rupture risk of larger AAAs.
- To assess the accuracy of existing studies considering competing risks.
Main Methods:
- A comprehensive literature search was conducted.
- Both quantitative and qualitative evaluations of the identified studies were performed.
Main Results:
- Twenty original papers were identified, exhibiting significant heterogeneity.
- Most studies likely overestimated AAA rupture rates due to neglecting competing risks.
- A recent, large study incorporating competing risk analysis estimated annual rupture rates for 55-69 mm AAAs.
Conclusions:
- Diameter-rupture risk relationships in most reports are flawed by failing to account for competing risks.
- The actual rupture risk for larger abdominal aortic aneurysms may be lower than commonly presumed.
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