Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair.
BACKGROUND
Among patients with abdominal aortic aneurysm (AAA) who have high operative risk, repair is usually deferred until the AAA reaches a diameter at which rupture risk is thought to outweigh operative risk, but few data exist on rupture risk of large AAA.


OBJECTIVE
To determine the incidence of rupture in patients with large AAA.


METHODS
Prospective cohort study in 47 Veterans Affairs medical centers.


METHODS
Veterans (n = 198) with AAA of at least 5.5 cm for whom elective AAA repair was not planned because of medical contraindication or patient refusal. Patients were enrolled between April 1995 and April 2000 and followed up through July 2000 (mean, 1.52 years).


METHODS
Incidence of AAA rupture by strata of initial and attained diameter.


RESULTS
Outcome ascertainment was complete for all patients. There were 112 deaths (57%) and the autopsy rate was 46%. Forty-five patients had probable AAA rupture. The 1-year incidence of probable rupture by initial AAA diameter was 9.4% for AAA of 5.5 to 5.9 cm, 10.2% for AAA of 6.0 to 6.9 cm (19.1% for the subgroup of 6.5-6.9 cm), and 32.5% for AAA of 7.0 cm or more. Much of the increased risk of rupture associated with initial AAA diameters of 6.5-7.9 cm was related to the likelihood that the AAA diameter would reach 8.0 cm during follow-up, after which 25.7% ruptured within 6 months.


CONCLUSIONS
The rupture rate is substantial in high-operative-risk patients with AAA of at least 5.5 cm in diameter and increases with larger diameter.
Lederle
Frank A
FA
Department of Medicine, Veterans Affairs Medical Center, Minneapolis, Minn 55417, USA. frank.lederle@med.va.gov
Johnson
Gary R
GR
Wilson
Samuel E
SE
Ballard
David J
DJ
Jordan
William D
WD
Blebea
John
J
Littooy
Fred N
FN
Freischlag
Julie A
JA
Bandyk
Dennis
D
Rapp
Joseph H
JH
Salam
Atef A
AA
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000473:pathology / Q000503:physiopathology*; D001019:Aortic Rupture / Q000453:epidemiology*; D015331:Cohort Studies; D000075202:Contraindications; D006801:Humans; D015994:Incidence; D008297:Male; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012306:Risk; D014656:Vascular Surgical Procedures