Variables that affect the expansion rate and outcome of small abdominal aortic aneurysms

Abstract

Seventy-three patients with small (less than 6 cm in diameter) abdominal aortic aneurysms (AAAs) were selected for nonoperative management and followed up with sequential ultrasound size measurements. Fifty-four men and 19 women, 51 to 89 years of age (mean 70 years), had an initial mean AAA size of 4.1 cm (anteroposterior) x 4.3 cm (lateral) diameter, with a calculated elliptic cross-sectional area of 14.3 cm2. After a mean of 37 months of follow-up, AAA area increased at a mean rate of 20% per year (3 cm2 yr; 0.4 to 0.5 cm/yr diameter). Expansion rate was not affected by initial aneurysm size. During follow-up, only 3 patients (4%) required urgent operation (1 died), 26 patients (36%) died of non-AAA causes, and 26 patients (36%) underwent elective AAA repair because of progressive size increase (1 died). Elective operations were performed at the rate of 10% per year, when mean AAA size had increased to 22 cm2 (5.1 cm in diameter). Multiple regression analysis of clinical parameters available at presentation indicated that subsequent elective AAA repair was predicted by younger age at diagnosis and larger initial aneurysm size. As anticipated, patients who underwent surgery had more rapid aneurysm expansion (5.3 cm2/yr) compared with patients who did not undergo surgery (1.6 cm2/yr; p less than 0.05). This difference was caused by more rapid expansion during later follow-up intervals among patients selected for operation and was not predicted by the change in aneurysm size observed during initial ultrasonographic follow-up. Final aneurysm size was predicted by initial size, duration of follow-up, and both systolic and diastolic pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery,⁎Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients

“…In a similar study of 101 patients with aneurysms measuring less than 5.0 cm in diameter, Valentine et al encountered no ruptures among patients who complied with their follow-up program compared with a 10% rupture rate among those who did not (1217). If continued surveillance is recommended, measures should be taken to control hypertension and to discourage smoking, because these risk factors are associated with accelerated rates of aneurysm growth (936,961). Ultimately, once an infrarenal aortic aneurysm reaches an appropriate size for graft replacement, a choice must be made between a traditional open operation or endovascular repair.…”

Ultrasonographic measurement of aortic diameter by emergency physicians approximates results obtained by computed tomography

“…Rupture of aneurysms less than 4 cm in diameter is a rare occurrence, but the expansion rate and the risk of rupture increase exponentially over time once the diameter of the AAA exceeds that measurement (7,8). Importantly, as many as two-thirds of AAAs go unrecognized before rupture, with overall mortality rates approaching 90% once this disaster has occurred (3,9 -12).…”

Abdominal aortic aneurysm surgery for octogenarians

“…16 Cronenwett et al also reported an approximate 10% increase per year. 17 According to our QOL evaluation by the SF-36, of the physical components evaluated, bodily pain worsened postoperatively but recovered within 12 months. Among the mental components, mental health alone improved postoperatively whereas the other three factors did not.…”