Small Abdominal Aortic Aneurysm Surveillance, Management, and Outcomes

To assess the clinical characteristics of small abdominal aortic aneurysms (AAAs) for growth patterns, growth rates, time to repair, and adverse outcomes relative to surveillance imaging intervals.

Patients with small AAAs (30-45 mm in diameter) and at least 1 follow-up imaging study were eligible for inclusion (January 1, 2014, through December 31, 2019). Variables impacting time to repair, rupture, or death were assessed.

Of 2044 unique patients with AAAs, a random sample of 299 patients (mean ± SD age, 70.5 ± 9.0 years; 18.7% female) were divided into slow-/no- (≤2 mm per year; n=116), intermediate- (>2 to <5 mm per year; n=150), and rapid- (≥5 mm per year; n=33) growth categories. During 10.0-year median follow-up, 61.2% of the patients (n=183) underwent repair. Rapid-growth AAAs were more likely to undergo repair (88% vs intermediate 81.7% or slow/no growth 26.5%; P<.001), required earlier repair (P<.001), and were more likely to die during follow-up (79% vs 41% or 56%; P=.045). Predictors of time to repair included index AAA size, diabetes mellitus, and β-blocker or diuretic therapy. Ruptures (n=1) or impending ruptures (n=4) during follow-up were greatest in the rapid- (n=2, 6.1%; P<.001) compared with the intermediate- (n=3, 2.0%) or slow-/no- (0%) growth groups.

Growth rate characteristics of AAAs influence repair-free survival, time to repair, overall survival, and rupture-free survival.