When to stop: Optimizing abdominal aortic aneurysm surveillance in the elderly

Area of Science:

• Vascular Surgery
• Geriatric Medicine
• Epidemiology

Background:

• Asymptomatic abdominal aortic aneurysms (AAAs) smaller than the intervention diameter often undergo lifelong surveillance.
• This approach may not be beneficial for all older adults, particularly those with comorbidities or advanced age.

Purpose of the Study:

• To identify subgroups of older adults with asymptomatic AAAs unlikely to progress to the intervention diameter before death.
• To inform patient-specific surveillance strategies based on age, comorbidities, and aneurysm size.

Main Methods:

• Analysis of a multicenter aneurysm registry (2007-2024) including patients aged 65+.
• Stratification of comorbidities using a validated risk index and assessment of AAA size via imaging.
• Time-to-event analysis to determine the probability of death versus aneurysm progression to intervention size.

Main Results:

• In unadjusted analyses, a significant proportion of aneurysms reached operable size before death, varying by gender and initial size.
• Women >85 years with AAAs <3.5 cm and men >80 years with AAAs <3.5 cm had a >90% probability of death before progression.
• Higher comorbidity burdens identified specific subgroups (e.g., older men, smokers) with >90% probability of death before AAA intervention.

Conclusions:

• Surveillance cessation is appropriate for women aged 85+ or men aged 80+ with AAAs <3.5 cm, given >90% probability of death before progression.
• Integrating comorbidity data with age and aneurysm diameter allows for personalized surveillance recommendations, optimizing care for older adults with AAAs.