Selective management of abdominal aortic aneurysms in a prospective measurement program

Area of Science:

• Vascular Surgery
• Aortic Aneurysm Management
• Clinical Decision Making

Background:

• Small abdominal aortic aneurysms (AAAs) (<5 cm) require careful management strategies.
• Patients unfit for surgery with larger AAAs (≥5 cm) present unique challenges.
• Determining optimal timing for intervention in AAAs is critical to prevent rupture.

Purpose of the Study:

• To clarify treatment strategies for small AAAs (<5 cm).
• To evaluate management of patients unfit for operation with AAAs ≥5 cm.
• To assess the risk of rupture and expansion rates in abdominal aortic aneurysms.

Main Methods:

• Prospective measurement program using ultrasonography or CT scans every 6 months for AAAs <5 cm.
• Operative fitness assessment when AAAs reached 5 cm.
• Inclusion of patients unfit for repair with AAAs ≥5 cm in the measurement program.

Main Results:

• Operation performed in 201 patients with initial AAAs <5 cm due to size increase or rapid expansion.
• Mean follow-up of 42 months for 291 patients with initial AAAs <5 cm who did not undergo operation.
• Expansion rate of 0.7 cm/year in AAAs measuring 4.5–4.9 cm at entry; 10 ruptures occurred in unfit patients with AAAs ≥5 cm.

Conclusions:

• Strong consideration for elective surgery in fit patients with AAAs between 4.5–5.0 cm is recommended.
• The risk of rupture in AAAs ≥5 cm necessitates careful monitoring and timely intervention.
• Progressive expansion rates in smaller AAAs support early surgical consideration.