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Rupture Rate of Large Abdominal Aortic Aneurysms in Patients Refusing or Unfit for Elective Repair
Frank A. Lederle, MD;
Gary R. Johnson, MS;
Samuel E. Wilson, MD;
David J. Ballard, MD, PhD;
William D. Jordan, Jr, MD;
John Blebea, MD;
Fred N. Littooy, MD;
Julie A. Freischlag, MD;
Dennis Bandyk, MD;
Joseph H. Rapp, MD;
Atef A. Salam, MD;
for the Veterans Affairs Cooperative Study #417 Investigators
JAMA. 2002;287:2968-2972.
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.
Author Affiliations: Department of Medicine, Veterans Affairs Medical Center, Minneapolis, Minn (Dr Lederle); Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, West Haven, Conn (Mr Johnson); Department of Surgery, University of California, Irvine, Orange, Calif (Dr Wilson); Baylor Health Care System, Dallas, Tex (Dr Ballard); Department of Surgery, Veterans Affairs Medical Center, Birmingham, Ala (Dr Jordan); Department of Surgery, Pennsylvania State University, Hershey (Dr Blebea); Department of Surgery, Veterans Affairs Medical Center, Hines, Ill (Dr Littooy); Department of Surgery, Veterans Affairs Medical Center, Los Angeles, Calif (Dr Freischlag); Department of Surgery, Veterans Affairs Medical Center, Tampa, Fla (Dr Bandyk); Department of Surgery, Veterans Affairs Medical Center, San Francisco, Calif (Dr Rapp); Department of Surgery, Veterans Affairs Medical Center, Atlanta, Ga (Dr Salam).
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