Expansion pattern and risk of rupture of abdominal aortic aneurysms that were not operated on

Abstract

Objective: To analyse the outcome of selective management of patients with abdominal aortic aneurysms, the expansion patterns of the aneurysms, and the factors that influenced the rate of rupture.

Design: Retrospective study.

Setting: Malmö General Hospital, Lund University, Malmö, Sweden.

Subjects: 155 patients (96 men and 59 women) with abdominal aortic aneurysms who were not selected for operation for whatever reason were included in the study immediately after their first ultrasound scan.

Main outcome measures: Mortality, expansion rate (mm/year) measured on ultrasound scan, and rate of rupture of aneurysm.

Results: Median aneurysmal diameter was 40 mm (range 20-80), and length (n = 106) 70 (range 28-140). The patients were followed up for a median of 3.4 years (range 0-10.2). A total of 107 patients died and in 21 the aneurysms ruptured (4 were operated on and survived). Thirteen patients were re-evaluated and operated on electively. Ultrasonography was repeated in 98 patients, the median expansion rates (mm/year) were 3.1 (diameter) and 1.9 (length). There was a significant linear relationship between initial size (diameter and length) and rate of expansion of diameter. The risk of rupture was greater in larger aneurysms that were expanding more quickly. The cumulative mortality was not affected by the 21 aneurysms that ruptured.

Conclusion: Selective management of patients with aortic aneurysms is justified.