Immediate Repair Compared with Surveillance of Small Abdominal Aortic Aneurysms

Lederle, Frank A.; Wilson, Samuel E.; Johnson, Gary R.; Reinke, Donovan B.; Littooy, Fred N.; Acher, Charles W.; Ballard, David J.; Messina, Louis M.; Gordon, Ian L.; Chute, Edmund P.; Krupski, William C.; Busuttil, Steven J.; Barone, Gary W.; Sparks, Steven R.; Graham, Linda M.; Rapp, Joseph H.; Makaroun, Michel S.; Moneta, Gregory L.; Cambria, Robert A.; Makhoul, Raymond G.; Eton, Darwin; Ansel, Howard J.; Freischlag, Julie A.; Bandyk, Dennis F.

doi:10.1056/nejmoa012573

Cited by 990 publications

(381 citation statements)

References 24 publications

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“…Os achados também se confirmaram no Aneurysm Detection and Management Veterans Affairs Cooperative Study 220 , em que 1136 pacientes com aneurismas infra-renais com diâmetro entre 4,0 e 5,4cm foram randomizados para tratamento cirúrgico (n=569) ou para controle ecográfico perió-dico (n=567). A mortalidade hospitalar no grupo operado foi de 2,7%, e não houve diferença na sobrevida em 5 anos entre os grupos.…”

Section: Recomendaçõesunclassified

Diretrizes para a cirurgia das doenças da aorta

Albuquerque¹,

Palma²,

Braile³

et al. 2004

Arq. Bras. Cardiol.

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Section: Recomendaçõesunclassified

Diretrizes para a cirurgia das doenças da aorta

Albuquerque¹,

Palma²,

Braile³

et al. 2004

Arq. Bras. Cardiol.

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“…A positive trend was noted in the immediate repair group after 10 years. A recent Veterans Administration study 12 led to similar findings despite a difference in operative mortality: 5.8% for the British vs. 2.7% for the Americans. The conclusions of these two studies were identical: delaying repair until AAA diameter reaches 5.5 cm does not result in significantly higher mortality provided that rigorous surveillance is performed.…”

Section: Natural History Of Aaamentioning

confidence: 73%

Conventional Abdominal Aortic Aneurysm Repair: Evidence-based Assessment

Limet¹

2003

Annals of Vascular Surgery

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Ruptured abdominal aortic aneurysm (AAA) is a frequent cause of death (9000 persons per year in the United States). Because open repair is highly effective in preventing rupture, surgeons advocate elective surgical treatment. With the trend toward evidence-based medicine, however, surgeons have come under strong pressure to justify their therapeutic decisions on the basis of objective data. The purpose of this study was to perform an evidence-based assessment of conventional surgical AAA repair.For surgical treatment of cancer, it is relatively easy to evaluate the effectiveness of surgery, since the survival rate of unoperated cancer is well documented and thus can be used as a reference for measuring the outcome of surgery. A similar knowledge of the natural history of AAA is prerequisite for determining whether the operative risk associated with open AAA repair is offset by a reduction in the risk of fatal aortic rupture, which is the goal of surgical treatment. In addition to risk/ benefit analysis, this study will seek to answer two questions. The first is the extent to which it is possible to evaluate the risk of rupture and thus to select indications on the basis of clinical and laboratory findings. The second is the seldom-asked question of whether endovascular treatment and even conventional open repair really rule out subsequent occurrence of rupture. Only by providing clear answers to these questions can we know if AAA repair is an evidenced-based procedure. NATURAL HISTORY OF AAAIn early reports such as those of Szilagyi et al., 1 the natural history of AAA was extremely poor. This is probably because most cases diagnosed at that time involved advanced aneurysms with large diameters. In the more recent literature mortality rates for unoperated AAA diagnosed using modern technology have been less alarming than those given by Szilagyi. However, these clinical data have also been challenged. 2 The best way to avoid the inherent bias in most clinical studies would be to use data from autopsy series from countries where postmortem studies are performed on a routine basis. One such study is available from the city of Malmo, Sweden, for the period between 1958 and 1986 (85% of deceased subjects). 3 As would be expected, this study showed that AAA is a predominantly male condition that becomes age-dependent after age 69 years, with a peak occurring during the eighth decade of life. The most interesting finding for the purpose of the present study is the number of ruptured AAA found during autopsy, i.e., 5.6 per year and per 100,000 inhabitants (8.4 for men and 3.0 for women). Peak incidence occurred between 80 and 89 years of age in men and over 90 years in women. In other countries such as England and Wales, the same age distribution has been observed, but with higher figures. 4 This corresponds to the absolute incidence of fatal ruptured AAA, but what is the relative incidence of fatal rupture in relation to the total number of AAA discovered during autopsy? Only 14% of the total number of AAA discovered d...

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“…I estimated monthly mortalities for cohorts at the start of the UK Small Aneurysm Trial (UK SAT) and the US Aneurysm Detection and Management (ADAM) trial as 1/249 (0.40%) and 1/317 (0.32%), respectively, for which the mean aneurysm diameter was 46 mm (ultrasound) and 47 mm (CT scan), respectively 8, 9. These diameters are similar to the 45 mm aneurysm group simulated in Table 1, for which immediate repair extended median survival by 3 years compared with delayed repair at 55 mm in a cohort with an initial mortality hazard of 0.5%.…”

Section: Resultsmentioning

confidence: 99%

Simulations of the effects of scheduled abdominal aortic aneurysm repair on survival

Carlisle

2015

Anaesthesia

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SummaryI simulated survival with and without scheduled repair of abdominal aortic aneurysms with different diameters in different populations. The results imply that scheduled repair should be determined by the combination of a patient's monthly mortality hazard and aneurysm diameter. The median survival of some patients will be extended by the scheduled repair of aneurysms smaller than 55 mm, whereas the median survival of other patients will be curtailed by repair of any aneurysm. The results also suggest that, on average, surveillance is futile: the effect of scheduled aneurysm repair on an individual's median survival did not change but the cohort effect diminished as patients died during surveillance. The results of the UK Small Aneurysm Study were reproduced in simulation and are compatible with the repair of aneurysms smaller than 55 mm diameter. Epidemiological simulations suggest that past randomised controlled trials underestimate the effect of aneurysm repair today.

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Immediate Repair Compared with Surveillance of Small Abdominal Aortic Aneurysms

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

Cited by 990 publications

References 24 publications

Diretrizes para a cirurgia das doenças da aorta

Diretrizes para a cirurgia das doenças da aorta

Conventional Abdominal Aortic Aneurysm Repair: Evidence-based Assessment

Simulations of the effects of scheduled abdominal aortic aneurysm repair on survival

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