A 14-year experience with 6 cm as a criterion for surgical treatment of abdominal aortic aneurysm

• Published in: British journal of surgery Vol. 86; no. 10; pp. 1317 - 1321
• Main Authors: Scott, R. A. P., Ashton, H. A., Lamparelli, M. J., Harris, G. J. C., Stevens, J. W.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.10.1999; Wiley
• Subjects: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the aorta; Female; Follow-Up Studies; Humans; Male; Mass Screening - methods; Medical sciences; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Ultrasonography; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Human; Indication; Aneurysm; Cardiovascular disease; Dimension; Result; Arterial disease; Vascular disease; Abdominal aorta; Prospective; Treatment; Surgery; Technique; Aortic disease
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1046/j.1365-2168.1999.01227.x

Background: It remains unclear when to recommend operation for an asymptomatic abdominal aortic aneurysm (AAA). This study examined a prospective series of patients for whom standard criteria were applied. Methods: Some 584 consecutive patients with an AAA of diameter 3 cm or greater detected by ultrasonographic screening have been observed for up to 14 years. Repeat ultrasonographic examinations have been performed at intervals. Surgery was not considered unless the aneurysm measured 6 cm in diameter, expanded at a rate equivalent to at least 1 cm per year, caused the patient symptoms, or an iliac aneurysm was present that required treatment. Results: Operation was performed on 127 patients; the majority (80; 63 per cent) had an aneurysm that reached 6 cm in diameter. Use of the above criteria prevented rupture in all but 24 (4 per cent) of the 584 patients over the 14‐year interval. Of these 24 patients, 11 were unfit for planned surgery and eight declined operation or follow‐up. Rupture in the five remaining patients (1 per cent) who were available for treatment compared favourably with the reported 30‐day mortality rate for elective surgical treatment of 1·4–12 per cent. Conclusion: Repeated observation is preferable to surgical intervention until an aortic aneurysm measures 6 cm in diameter, expands by 1 cm per annum or causes symptoms. © 1999 British Journal of Surgery Society Ltd