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Possible objectification of a critical maximum diameter for elective surgery in abdominal aortic aneurysms based on
W A Cappeller1, H Engelmann, S Blechschmidt
1Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany.
Background:
The purpose of this study was to evaluate the ratio of aneurysm size to aortic diameter (dm/ds) and newly defined volumetric parameters and to objectify by means of these parameters a critical maximum diameter (dm) as indicator for elective surgery of abdominal aortic aneurysms (AAA).
Methods:
Based on contrast-enhanced CT scans one- and three-dimensional parameters were measured in 3 groups of n=58 patients selected for a) emergency surgery (n=13) in case of contained rupture and b) elective surgery (n=29) or c) non operative follow-up (n=16) if the AAA was bigger or smaller than 4.5 cm in dm. Ignoring these groups the statistically independent ratios dm/ds and thrombus to aneurysm volume (TV/AV) of all patients were retrospectively subjected to cluster and regression analyses in order to find out possible critical values confirming a dm-based decision. Thrombus (TV) and aneurysm volume (AV) correlated with increasing diameter.
Results:
The ratio TV/AV predominantly increased from 0.42 to 0.65 in aneurysms 5 to 8 cm in diameter, reaching a maximum of 0.8 in AAA with contained rupture. A TV/AV of 0.45 and a dm/ds of 2.0 were found to be separators of two distinguished groups confirming a critical dm of about 5 cm.
Conclusions:
The newly defined volumetric ratio TV/AV and dm/ds may objectify the dm-based decision for elective surgery or follow-up treatment. Prospective studies have to evaluate this approach.