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What is the long-term outcome for patients with very small abdominal aortic aneurysms?
1Nuffield Department of Surgery, John Radcliffe Hospital, Oxford, U.K.
Insights
Abdominal aortic aneurysms (AAA) under 4 cm grow slowly and are generally benign. This suggests that early intervention for very small AAA may not be appropriate, warranting a reevaluation of current guidelines.
Area of Science:
- Vascular Surgery
- Aortic Disease Management
- Population Health Screening
Background:
- Abdominal aortic aneurysms (AAA) are a significant vascular condition.
- Management guidelines for small AAAs (less than 4 cm) are debated.
- Long-term outcomes for very small AAAs require further investigation.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of patients diagnosed with abdominal aortic aneurysms (AAA) measuring less than 4 cm in anterior-posterior diameter.
- To assess the growth rate and complication incidence in a cohort of very small AAAs.
Main Methods:
- A population-based screening study involving 142 patients with AAA < 4 cm.
- Ultrasound surveillance at 6-12 month intervals.
- Review of patient records for growth, intervention, and mortality data.
Main Results:
- Median annual growth rates were 1 mm (<3 cm), 2 mm (3.0-3.9 cm), and 3 mm (4.0-4.9 cm).
- The threshold for elective repair increased from 4 cm to 5.5 cm over 9 years.
- More patients died with their aneurysm (35) than underwent surgical repair (23).
Conclusions:
- Very small abdominal aortic aneurysms (<4 cm) demonstrate relatively benign behavior.
- The findings question the current appropriateness of early surgical intervention for these small AAAs.
- Conservative management and surveillance may be suitable for select patients with very small AAAs.
Objective:
To determine the long-term outcome for patients with abdominal aortic aneurysms (AAA) less than 4 cm in AP diameter (very small AAA).
Design:
Population-based screening study.
Materials And Methods:
One hundred and forty-two patients who had AAA less than 4 cm at presentation were assessed by ultrasound at intervals of 6-12 months. The records of these patients were reviewed.
Results:
During the period of follow-up the median annual growth rate for aneurysms while under 3.0 cm was 1 mm, rising to 2 mm when between 3.0 and 3.9 cm, and 3 mm when between 4.0 and 4.9 cm in diameter. Elective aneurysm repair was undertaken when aneurysms exceeded the threshold value, which itself increased from 4 cm to 5.5 cm in the 9 years of follow-up. More patients died with their aneurysm (n = 35) then underwent surgery (n = 23). There was one perioperative death, and three unrelated late deaths after resection. One aneurysm ruptured in a patient who had refused follow-up 5 years previously.
Conclusions:
This study suggests that aneurysms less than 4.0 cm diameter are relatively benign, and questions the appropriateness of early intervention.