Abdominal aortic aneurysm rupture rates: a 7-year follow-up of the entire abdominal aortic aneurysm population detected by screening.
OBJECTIVE
The goal of the current study was to identify the risk of rupture in the entire abdominal aortic aneurysm (AAA) population detected through screening and to review strategies for surgical intervention in light of this information.


METHODS
Two hundred eighteen AAAs were detected through ultrasound screening of a family practice population of 5394 men and women aged 65 to 80 years. Subjects with an AAA of less than 6.0 cm in diameter were followed prospectively with the use of ultrasound, according to our protocol, for 7 years. Patients were offered surgery if symptomatic, if the aneurysm expanded more than 1.0 cm per year, or if aortic diameter reached 6.0 cm.


RESULTS
The maximum potential rupture rate (actual rupture rate plus elective surgery rate) for small AAAs (3.0 to 4.4 cm) was 2.1% per year, which is less than most reported operative mortality rates. The equivalent rate for aneurysms of 4.5 to 5.9 cm was 10.2% per year. The actual rupture rate for aneurysms up to 5.9 cm using our criteria for surgery was 0.8% per year


CONCLUSIONS
In centers with an operative mortality rate of greater than 2%, (1) surgical intervention is not indicated for asymptomatic AAAs of less than 4.5 cm in diameter, and (2) elective surgery should be considered only for patients with aneurysms between 4.5 and 6 cm in diameter that are expanding by more than 1 cm per year or for patients in whom symptoms develop. In centers with elective mortality rates of greater than 10% for abdominal aortic aneurysm (AAA) repair, the benefit to the patient of any surgical intervention for an asymptomatic AAA of less than 6.0 cm in diameter is questionable.
Department of Vascular Surgery, St. Richard's Hospital, Chichester, West Sussex, United Kingdom.
R A
RA
Scott
P V
PV
Tisi
H A
HA
Ashton
D R
DR
Allen
D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000473:pathology; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology