In current abdominal aortic aneurysm (AAA) screening programs, surveillance intervals of several years may be clinically acceptable for the majority of patients with small AAA.
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To better guide AAA surveillance efforts, Simon G. Thompson, D.Sc., of the University of Cambridge, England, and colleagues conducted a study to determine the rates at which small AAAs progress to reach the surgery threshold diameter of 5.5 cm and the risk of AAA rupture over time. Via a meta-analysis, the authors assessed individual patient data from studies of small AAA growth and rupture. A total of 18 studies containing records from 15,471 individual patients (13,728 men and 1,743 women) under surveillance for small AAAs were included in the analyses. Most studies used 5.5 cm as the threshold for surgical intervention, used only ultrasound scans, and recorded external aortic diameters.
The researchers found that AAA growth and rupture rates varied considerably across studies. Each 0.5-cm increase in baseline AAA diameter resulted in a 0.59-mm per year increase in average aortic growth rate. Rupture rates in men increased by a factor of 1.9 for every 0.5-cm increase in baseline AAA diameter. For men with a 3.0-cm AAA, the estimated average time taken to have a 10 percent chance of reaching the surgery threshold diameter 5.5 cm was 7.4 years. The corresponding average times for 4.0 cm- and 5.0 cm-AAAs were 3.2 years and 8 months, respectively.
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While absolute growth rates were similar for women and men (particularly for larger baseline AAA diameters), there were marked differences in the absolute risks of rupture. Women had a 4-fold greater rupture risk for all AAA sizes and reached a rupture risk of greater than 1 percent in a much shorter time than men.
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"There is a need for more research regarding women with aneurysms in the diameter range of 4.5 to 5.4 cm. Since national rates of AAA rupture are declining, recommended surveillance intervals may need to be reassessed. There is also a need to establish the cost effectiveness of different surveillance policies. Decreasing surveillance frequency would reduce surveillance costs. However, it may also slightly increase rupture rates and increase patient anxiety. This would decrease overall life expectancy and quality of life in AAA patients under surveillance and increase costs attributable to emergency surgery," the researchers conclude.
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