title: Surveillance of small aortic aneurysms does not alter anatomic suitability for endovascular repair.
abstract: OBJECTIVE
  Small abdominal aortic aneurysms (AAAs; 4-5.4 cm) are more likely to be suitable for endovascular aneurysm repair (EVAR) than large aortic aneurysms (>5.5 cm). The purpose of this study was to determine whether small AAA growth is associated with the development of morphologic characteristics that decrease eligibility for EVAR.
  
  
  METHODS
  We studied 54 patients who underwent 2 or more computed tomography scans with 3-dimensional reconstruction during surveillance of small AAAs. Morphologic aortic aneurysm features and changes were measured according to Society for Vascular Surgery reporting standards. Suitability for EVAR was determined by neck anatomy (diameter, length, and angulations), iliac artery morphology, and total aortic aneurysm angulation and tortuosity.
  
  
  RESULTS
  The median age of the study cohort was 73 years (interquartile range [IQR], 65-77 years). The median follow-up period was 24 months (IQR, 15-36 months). The median small AAA diameter increased from 44.5 mm (IQR, 41-48 mm) to 48.9 mm (IQR, 45.7-52.0 mm). The median aortic neck diameter increased from 23.0 to 24.0 mm (P = .002), whereas median neck length decreased from 26.5 to 20.0 mm (P = .001). Aortic aneurysm median tortuosity index increased from 1.09 to 1.11 (P = .05). No significant changes in iliac artery morphology occurred. Overall, the anatomic suitability for endovascular repair did not significantly change during the study period (74% vs 69%; McNemar test; P = .25).
  
  
  CONCLUSIONS
  Changes in aortic morphology are frequently associated with small AAA growth at mid-term follow-up, but such changes are minor and do not affect overall anatomic suitability for EVAR. These data reveal that continued surveillance of small AAAs does not threaten the window of opportunity for EVAR.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9157, USA.
authors.forename: Franklin S
authors.initials: FS
authors.lastname: Yau
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rosero
authors.forename: G Patrick
authors.initials: GP
authors.lastname: Clagett
authors.forename: R James
authors.initials: RJ
authors.lastname: Valentine
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Modrall
authors.forename: Frank R
authors.initials: FR
authors.lastname: Arko
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Timaran
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed