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Previous Volume 346:1437-1444 May 9, 2002 Number 19 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Thompson, R. W. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Whether elective surgical repair of small abdominal aortic aneurysms improves survival remains controversial.

Methods We randomly assigned patients 50 to 79 years old with abdominal aortic aneurysms of 4.0 to 5.4 cm in diameter who did not have high surgical risk to undergo immediate open surgical repair of the aneurysm or to undergo surveillance by means of ultrasonography or computed tomography every six months with repair reserved for aneurysms that became symptomatic or enlarged to 5.5 cm. Follow-up ranged from 3.5 to 8.0 years (mean, 4.9).

Results A total of 569 patients were randomly assigned to immediate repair and 567 to surveillance. By the end of the study, aneurysm repair had been performed in 92.6 percent of the patients in the immediate-repair group and 61.6 percent of those in the surveillance group. The rate of death from any cause, the primary outcome, was not significantly different in the two groups (relative risk in the immediate-repair group as compared with the surveillance group, 1.21; 95 percent confidence interval, 0.95 to 1.54). Trends in survival did not favor immediate repair in any of the prespecified subgroups defined by age or diameter of aneurysm at entry. These findings were obtained despite a low total operative mortality of 2.7 percent in the immediate-repair group. There was also no reduction in the rate of death related to abdominal aortic aneurysm in the immediate-repair group (3.0 percent) as compared with the surveillance group (2.6 percent). Eleven patients in the surveillance group had rupture of abdominal aortic aneurysms (0.6 percent per year), resulting in seven deaths. The rate of hospitalization related to abdominal aortic aneurysm was 39 percent lower in the surveillance group.

Conclusions Survival is not improved by elective repair of abdominal aortic aneurysms smaller than 5.5 cm, even when operative mortality is low.

Source Information

From the Veterans Affairs Medical Centers in Minneapolis (F.A.L., D.B.R., E.P.C.), Long Beach, Calif. (S.E.W., I.L.G.), West Haven, Conn. (G.R.J.), Hines, Ill. (F.N.L.), Madison, Wis. (C.W.A.), San Francisco (L.M.M.), Denver (W.C.K.), and Tampa, Fla. (D.B.); and the Baylor Health Care System, Dallas (D.J.B.).

Other authors (all at Veterans Affairs Medical Centers) were Steven J. Busuttil, M.D., Cleveland; Gary W. Barone, M.D., Little Rock, Ark.; Steven Sparks, M.D., San Diego, Calif.; Linda M. Graham, M.D., Ann Arbor, Mich.; Joseph H. Rapp, M.D., San Francisco; Michel S. Makaroun, M.D., Pittsburgh; Gregory L. Moneta, M.D., Portland, Oreg.; Robert A. Cambria, M.D., Milwaukee; Raymond G. Makhoul, M.D., Richmond, Va.; Darwin Eton, M.D., Miami; Howard J. Ansel, M.D., Minneapolis; and Julie A. Freischlag, M.D., Los Angeles.

Address reprint requests to Dr. Lederle at the Department of Medicine (III-0), Veterans Affairs Medical Center, Minneapolis, MN 55417, or at frank.lederle{at}med.va.gov.

Full Text of this Article

Related Letters:

Small Abdominal Aortic Aneurysms
Kertai M. D., Boersma E., Poldermans D., Finucane T. E., Miller C. C. III, Huynh T. T., Safi H. J., Ballotta E., Toniato A., Lederle F. A., the Aneurysm Detection and Management Veterans Affairs Cooperative Study Group , Powell J., Brady T., Greenhalgh R., the United Kingdom Small Aneurysm Trial Participants
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N Engl J Med 2002; 347:1112-1115, Oct 3, 2002. Correspondence

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