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PVSS8. Growth Predictors Of Small Abdominal Aortic Aneurysms. Possible Consequences For Small Aneurysm Treatment Strategies

Felix J. V. Schlösser, Hence J. M. Verhagen, Marco J. Tangelder, Geert J. M. G. van der Heijden, Yolanda van der Graaf, Frans L. Moll.
University Medical Center Utrecht, Department of Vascular Surgery, Utrecht, Intl., Netherlands.
 
OBJECTIVES: To provide insight into the impact of cardiovascular risk factors, comorbidities and patient characteristics on growth rates of small abdominal aortic aneurysms (AAA).

METHODS: Between September 1996 and January 2005, 5057 patients with manifest arterial vascular disease or cardiovascular risk factors were included in the SMART study: Second Manifestation of ARTerial disease. Measurements of the abdominal aortic diameter were performed in all patients. All patients with an initial AAA diameter between 30 and 55 mm were selected for this study. Kaplan-Meier analysis was used for calculation of survival rates. Multivariate regression analysis was performed to test the effect of demographic patient characteristics, AAA diameters and cardiovascular risk factors on AAA growth.

RESULTS: Included were 230 patients, 66 years of age on average and 90% was male. Mortality rates for 2 and 5 years were 7.8% and 25.4% (352 and 455 patient years). 4 AAA ruptures occurred in total (in 984 patient years), all fatal and all in AAAs larger than 50 mm in diameter. In 109 patients, AAA measurements were performed for a period of more than 6 months. The median follow-up time of these patients was 3.3 years (range 0.5 to 11.0 years). Mean AAA diameter was 40.7 mm (standard deviation 6.7) and median expansion rate 2.8 mm/year (mean 3.5; standard deviation 3.3). Patients that were using lipid-lowering drugs had a 1.4 mm/year lower AAA growth rate compared to non-users of these drugs (95% CI -2,66 to -0,23 mm/year difference, significantly). Other factors were not independently associated with AAA growth.

CONCLUSIONS: Screening of patients with cardiovascular risk factors for AAA is recommendable. Because the rupture risk of small abdominal aortic aneurysms is small, watchful waiting is preferable to surgical treatment. Lipid-lowering drug treatment appears to be associated with lower AAA growth rates.