High proportion of known abdominal aortic aneurysm in patients with rupture indicates surveillance deficiency.
OBJECTIVE
This study assessed the proportion of previously known abdominal aortic aneurysm (AAA) in patients presenting with a ruptured AAA (rAAA) and analyzed the reasons for nontreatment at the time of the initial AAA diagnosis.


METHODS
This retrospective, observational study included all patients with rAAA admitted to a hospital in the counties of Stockholm and Gotland during 2009 to 2013. The patients' records were retrospectively reviewed, with extraction of data on previously detected AAA, demographics, and mortality at 30 and 90 days.


RESULTS
We identified 283 patients (76% men) with a mean age of 78.7 years. An AAA had been previously detected in 85 (30%). The overall mortality was higher (68% vs 53%; P = .018) and the intervention rate was lower in patients with a previously detected AAA (59% vs 82%, P < .001). The 90-day mortality rate for all treated rAAA was 43%. Reasons for nontreatment at the initial AAA detection were denial of elective surgery in 31 (36%), patient choice in 15 (18%), size-related in 11 (13%), and surveillance deficiency in 26 (31%). The latter group included patients who failed to comply, missed referral for computed tomography scans, and lack of follow-up of radiology reports. At the time of rupture, 22 patients (85%) were treated, with 30-day and 90-day mortality rates both at 41% (n = 9).


CONCLUSIONS
One-third of patients admitted with a rAAA had a previously detected AAA. The surgeons' decision to deny elective surgery and surveillance deficiency were the two main reasons for nontreatment at time of the AAA diagnosis. Improved patient-specific protocols to reduce the surveillance gaps and new methods of determining rupture risk in each case of AAA could be two possible future strategies to reduce the incidence of rupture.
Department of Surgery, Section for Vascular Surgery, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
Sayid
S
Zommorodi
Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Joy
J
Roy
Department of Surgery, Section for Vascular Surgery, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
Johnny
J
Steuer
Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. Electronic address: rebecka.hultgren@ki.se.
Rebecka
R
Hultgren
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D001027:Aortography / Q000379:methods; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010349:Patient Compliance; D057240:Patient Preference; D011237:Predictive Value of Tests; D011379:Prognosis; D012017:Referral and Consultation; D016079:Refusal to Treat; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016312:Treatment Refusal; D057832:Watchful Waiting