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Precocious rupture of abdominal aortic aneurysms below size criteria for repair: Risk factors and outcomes. Annals of vascular surgery George, E. L., Smith, J. A., Colvard, B., Lee, J. T., Stern, J. R. 2023

Abstract

INTRODUCTION: Practice guidelines recommend elective repair for abdominal aortic aneurysms (AAA) =5.5cm in men and =5cm in women to prevent rupture; however, some rupture at smaller diameters. We identify risk factors for rupture (rAAA) below this threshold and compare outcomes following rAAA repair above/below size criteria.METHODS: The Vascular Quality Initiative (2013-2019) was queried for patients undergoing repair for rAAA and stratified based on diameter into Small and Large cohorts [Small: <5.5cm (men), <5.0cm (women)]. Univariate analysis was performed, and Kaplan-Meier analysis compared overall survival, aneurysm-related mortality, and reintervention at 12-months.RESULTS: 5,162 rAAA were identified. Small rAAA patients [n = 588] were more likely to have hypertension (81.3% vs. 77.0%, p<0.02), diabetes (18.2% vs. 14.9%, p<0.04), and ESRD (2.9% vs. 0.9%, p<0.01), and be on optimal medical therapy (32.1% vs. 26.8%, p<0.01). Women were more likely to rupture at smaller diameters compared to men (p<0.01). Small rAAA patients were more likely to undergo EVAR (70.2% vs. 56.0%, p<0.01), and had lower in-hospital mortality (17.7% vs. 27.7%, p<0.01), and fewer perioperative complications across all categories. At 12-months, small rAAA patients had better overall survival, freedom from aneurysm-related mortality, and freedom from reintervention, largely driven by EVAR approach.CONCLUSION: More than 11% of patients presenting with ruptured AAA were below the recommended size threshold for repair, and they tended to be younger, non-white, and have hypertension, diabetes and/or renal failure. Patients with small rAAA experienced lower in-hospital morbidity and mortality and improved 1-year survival, and EVAR was associated with better outcomes than open repair. However, women more frequently rupture at smaller diameters compared to men. Given contemporary elective outcomes for women, a randomized controlled trial for EVAR vs. surveillance at a sex-specific size threshold is needed.

View details for DOI 10.1016/j.avsg.2023.05.008

View details for PubMedID 37247834