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Men with small, medium AAA require monitoring, not repair
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Men with a small or medium abdominal aortic aneurysm detected on screening had low risk for rupture and should be monitored but not referred for repair, researchers wrote in Circulation.
The researchers analyzed 18,652 men identified by the United Kingdom’s National Health Service AAA Screening Programme as having a small AAA, defined as a diameter of 3 cm to 4.4 cm, or a medium AAA, defined as a diameter of 4.5 cm to 5.4 cm. Current guidelines recommend AAA repair only for AAA of 5.5 cm or larger.
Clare Oliver-Williams, PhD, from the Cardiovascular Epidemiology Unit, department of public health and primary care, University of Cambridge, and colleagues analyzed outcomes, including ruptured AAA and death, in the cohort over 50,103 person-years of surveillance.
During the surveillance period, 31 men had ruptured AAA, of whom 29 died, according to the researchers.
In men with small AAA, the risk for ruptured AAA was 0.03% per year (95% CI, 0.02-0.05), and in men with medium AAA, the risk for ruptured AAA was 0.28% (95% CI, 0.17-0.44), Oliver-Williams and colleagues wrote.
For men with ruptured AAA just below the referral threshold, defined as a diameter of 5 cm to 5.4 cm, the annual risk for ruptured AAA was 0.4% (95% CI, 0.22-0.73), according to the researchers.
During the study, 952 men died from causes other than ruptured AAA, and the overall mortality rate was 1.96%, which did not significantly differ between men with small AAA and men with medium AAA, the researchers wrote, noting the most common causes of death were cancer (31.2%) and CV complications (26.3%).
“It can be concluded that men with small and medium screen-detected AAA are safe, provided they are enrolled in an intensive surveillance program, and that there is no evidence that the current referral threshold of 5.5 cm should be changed,” Oliver-Williams and colleagues wrote. – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.
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