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Monitoring Small AAAs Can Be Enough

Immediate repair of small abdominal aortic aneurysms did not improve survival in this study.

Patients with small abdominal aortic aneurysms (AAAs) may choose surgical repair or be monitored periodically. Unfortunately, little research is available to guide this decision.

These VA investigators randomized 1136 patients (age range, 50 to 79; 99% male) with small AAAs (4.0 cm to 5.4 cm) to immediate open repair or to surveillance with ultrasound or computed tomography every 6 months. Surveillance patients underwent surgery if the AAA grew to exceed 5.5 cm, expanded by 0.7 cm within 6 months (or by 1.0 cm within 1 year), or became symptomatic. Mean follow-up was 5 years.

Rates of surgery were 92.6% in the repair group (including 72.1% within 6 weeks of randomization) and 61.6% in the surveillance group. Five-year mortality rates were similar: repair, 25%; surveillance, 22%. During the study, 2 ruptures occurred in the repair group and 11 occurred in the surveillance group (including 2 that were found incidentally during elective repair). The repair-related 30-day mortality rate for the 2 groups overall was 2.4%.

Comment: Immediate repair of small AAAs did not improve survival in this study. Notably, however, the surveillance group had regular follow-up, which may have reduced their risk for rupture.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology June 28, 2002

Citation(s):

Lederle FA et al. for the Aneurysm Detection and Management Veterans Affairs Cooperative Study Group. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 2002 May 9; 346:1437-44.

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