title: Risk of rupture of large abdominal aortic aneurysms. Disagreement among vascular surgeons.
abstract: BACKGROUND
  Many patients with an abdominal aortic aneurysm (AAA) who are cared for by internists are not good candidates for surgery. Elective repair is usually deferred in these patients until the AAA reaches a diameter at which the estimated risk of rupture is believed to outweigh the operative risk. The risk of rupture is usually estimated by a consulting vascular surgeon, but whether these estimates are well-supported or consistent has not previously been assessed.
  
  
  OBJECTIVE
  To determine the agreement among vascular surgeons about the risk of rupture of large AAAs.
  
  
  METHODS
  All individual members of the Society for Vascular Surgery (Manchester, Mass) residing in the United States were mailed a survey asking for their estimates of the likelihood of rupture of large AAAs.
  
  
  RESULTS
  The response rate was 66% and the 257 respondents who reported that they were practicing vascular surgeons constitute the study group. The median estimates of the 1-year risk of rupture were 20% for 6.5-cm AAAs and 30% for 7.5-cm AAAs, with one third of respondents estimating 50% or greater risk of rupture for 7.5-cm AAAs and nearly one third estimating 50% or greater risk of rupture for 6.5-cm AAAs. The responses spanned a wide range and were generally much higher than would be expected based on published data and estimates.
  
  
  CONCLUSIONS
  This survey demonstrates profound disagreement among vascular surgeons about the risk of rupture of large AAAs, reflecting a lack of pertinent published data. Better data are necessary and are being collected.
authors.affiliation: Department of Medicine, Minneapolis Veterans Affairs Medical Center, University of Minnesota, USA lederle@minneapolis.va.gov
authors.forename: F A
authors.initials: FA
authors.lastname: Lederle
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000473:pathology / Q000601:surgery; D001019:Aortic Rupture / Q000209:etiology; D001291:Attitude of Health Personnel; D003625:Data Collection; D006801:Humans; D012306:Risk; D013997:Time Factors; D014656:Vascular Surgical Procedures