What is the long-term outcome for patients with very small abdominal aortic aneurysms?
OBJECTIVE
To determine the long-term outcome for patients with abdominal aortic aneurysms (AAA) less than 4 cm in AP diameter (very small AAA).


METHODS
Population-based screening study.


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.
Watson
C J
CJ
Nuffield Department of Surgery, John Radcliffe Hospital, Oxford, U.K.
Walton
J
J
Shaw
E
E
Heather
B
B
Collin
J
J
D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography