Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair

Frank A. Lederle, Gary R. Johnson, Samuel E. Wilson, David J. Ballard, William D. Jordan, John Blebea, Fred N. Littooy, Julie A. Freischlag, Dennis Bandyk, Joseph H. Rapp, Atef A. Salam

Research output: Contribution to journalArticle

409 Scopus citations

Abstract

Context: Among patients with abdominal aortic aneurysm (AAA) who have high operative risk, repair is usually deferred until the AAA reaches a diameter at which rupture risk is thought to outweigh operative risk, but few data exist on rupture risk of large AAA. Objective: To determine the incidence of rupture in patients with large AAA. Design and Setting: Prospective cohort study in 47 Veterans Affairs medical centers. Patients: Veterans (n=198) with AAA of at least 5.5 cm for whom elective AAA repair was not planned because of medical contraindication or patient refusal. Patients were enrolled between April 1995 and April 2000 and followed up through July 2000 (mean, 1.52 years). Main Outcome Measure: Incidence of AAA rupture by strata of initial and attained diameter. Results: Outcome ascertainment was complete for all patients. There were 112 deaths (57%) and the autopsy rate was 46%. Forty-five patients had probable AAA rupture. The 1-year incidence of probable rupture by initial AAA diameter was 9.4% for AAA of 5.5 to 5.9 cm, 10.2% for AAA of 6.0 to 6.9 cm (19.1 % for the subgroup of 6.5-6.9 cm), and 32.5% for AAA of 7.0 cm or more. Much of the increased risk of rupture associated with initial AAA diameters of 6.5-7.9 cm was related to the likelihood that the AAA diameter would reach 8.0 cm during follow-up, after which 25.7% ruptured within 6 months. Conclusion: The rupture rate is substantial in high-operative-risk patients with AAA of at least 5.5 cm in diameter and increases with larger diameter.

Original languageEnglish (US)
Pages (from-to)2968-2972
Number of pages5
JournalJournal of the American Medical Association
Volume287
Issue number22
StatePublished - Jun 12 2002
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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    Lederle, F. A., Johnson, G. R., Wilson, S. E., Ballard, D. J., Jordan, W. D., Blebea, J., Littooy, F. N., Freischlag, J. A., Bandyk, D., Rapp, J. H., & Salam, A. A. (2002). Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. Journal of the American Medical Association, 287(22), 2968-2972.