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Previous Volume 346:1445-1452 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 Two clinical trials, one British and one American, have shown that early, prophylactic elective surgery does not improve five-year survival among patients with small abdominal aortic aneurysms. We report long-term outcomes in the United Kingdom Small Aneurysm Trial.

Methods We randomly assigned 1090 patients, 60 to 76 years of age, with small abdominal aortic aneurysms (diameter, 4.0 to 5.5 cm) to one of two groups: 563 were assigned to undergo early elective surgery, and 527 were assigned to undergo surveillance by ultrasonography. Patients were followed in the trial until June 1998 and thereafter until August 2001; the mean duration of follow-up was 8 years (range, 6 to 10).

Results The mean duration of survival was 6.5 years among patients in the surveillance group, as compared with 6.7 years among patients in the early-surgery group (P=0.29). The adjusted hazard ratio for death from any cause in the early-surgery group as compared with the surveillance group was 0.83 (95 percent confidence interval, 0.69 to 1.00; P=0.05). The 30-day operative mortality in the early-surgery group (5.5 percent) led to an early disadvantage in terms of survival. The survival curves crossed at three years, and at eight years, mortality in the early-surgery group was 7.2 percentage points lower than that in the surveillance group (P=0.03). There was no evidence that age, sex, or the initial size of the aneurysm modified the hazard ratio or that delayed surgery in the surveillance group increased 30-day postoperative mortality. Death was attributable to a ruptured aneurysm in 19 of the 411 men who died (5 percent) and in 12 of the 85 women who died (14 percent) (P=0.001). The rate of early cessation of smoking was higher in the early-surgery group than in the surveillance group.

Conclusions Among patients with a small abdominal aortic aneurysm, we found no long-term difference in mean survival between the early-surgery and surveillance groups, although after eight years, total mortality was lower in the early-surgery group. This difference may be attributed in part to beneficial changes in lifestyle adopted by members of the early-surgery group.

Source Information

The Writing Committee (A.R. Brady, L.C. Brown, F.G.R. Fowkes, R.M. Greenhalgh, J.T. Powell, C.V. Ruckley, and S.G. Thompson) assumes overall responsibility for the content of the manuscript.

Address reprint requests to Dr. Powell at University Hospitals of Coventry and Warwickshire, Clifford Bridge Rd., Walsgrave, Coventry CV2 2DX, United Kingdom, or at janet.powell{at}wh-tr.wmids.nhs.uk.

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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