Unoperated aortic aneurysm: a survey of 170 patients

From 1984 to 1993, 1,053 patients were admitted with aortic aneurysm (AA) and 170 (15%) were not operated on. The most frequent reason for nonoperative management was presumed technical inoperability. Survivals for patients with thoracic, thoracoabdominal, and abdominal AA were comparable. No significant differences in survival for patients with dissecting and nondissecting AA were detected. In all, 132 patients (78%) died and 78 (59%) of them died of rupture. Mean time to rupture was 1,300 +/- 8 days. Cumulative 5-year hazard of rupture for the dissecting AA was twice that of the nondissecting (p < 0.001). Hazards of rupture for type A and B dissections were comparable. Diameter of 6 cm or greater was associated with a fivefold increase in cumulative hazard of rupture (p < 0.001). Diameter of AA, incidence of renal failure, and arterial hypertension were predictive of mortality, whereas the first two variables were predictive of rupture. In conclusion, because the majority of patients in all subgroups died of rupture, all patients should be recognized as candidates for surgical treatment. Present data justify aggressive approach to the patient with AA 6 cm or more in diameter and type A dissections. The results suggest that type B dissections may have a more favorable course if operated on, but a prospective, randomized study is necessary to confirm this observation. We believe that older patients and those with a small aneurysm may benefit from early, elective operation.