Is It Valid to Follow up Abdominal Aortic Aneurysms Smaller Than 5cm in Diameter?

• Watanabe Tetsuo

  Division of Advanced Surgical Science and Technology, Tohoku University

• Sato Akira

  Division of Advanced Surgical Science and Technology, Tohoku University

• Hashizume Eiji

  Division of Advanced Surgical Science and Technology, Tohoku University

• Goto Hitoshi

  Division of Advanced Surgical Science and Technology, Tohoku University

• Handa Kazuyoshi

  Division of Advanced Surgical Science and Technology, Tohoku University

• Akamatsu Daijirou

  Division of Advanced Surgical Science and Technology, Tohoku University

• Sato Hiroko

  Division of Advanced Surgical Science and Technology, Tohoku University

• Shimizu Takuya

  Division of Advanced Surgical Science and Technology, Tohoku University

• Nakano Yoshiyuki

  Division of Advanced Surgical Science and Technology, Tohoku University

• Satomi Susumu

  Division of Advanced Surgical Science and Technology, Tohoku University

Bibliographic Information

Other Title

• ５ｃｍ未満の腹部大動脈りゅうを経過観察することは妥当か？

Abstract

Background: We have performed elective surgery for abdominal aortic aneurysm (AAA) in accordance with our policy that 5 cm is the best threshold for repair of AAA. We conducted a retrospective study to determine whether our policy is valid in all our patients with AAA. Methods: All 260 patients who presented at Tohoku University Hospital with AAAs ≥4 cm between 1996 and 2003 were reviewed. We examined the size of the aneurysm at the first presentation, operation for AAA, length of survival and cause of death. We divided patients into two groups. One was the patients who received early surgery and the other is those who were observed and follow up. The latter group was further divided in two subgroups: the 4 cm-observation group in which the size of the aneurysm was smaller than 5 cm in diameter and the 5 cm-observation group in which the size of aneurysm was larger than 5 cm at first presentation. We investigated the outcome and compared the groups. Results: Among these patients, 125 patients (48.1%) underwent early elective operation (early surgery group) and 135 patients (51.9%) were not offered operative treatment (4 cm-observation group: 92,5 cm-observation group: 43). Almost all patients in the early surgery group had an AAA of 5 cm or greater. In 52 cases in the observation group, additional elective surgery was performed during the follow-up period, and all of those 52 patients had an AAA of 5 cm or greater. Rupture of the aneurysm occurred in 14 cases in the observation group and all ruptured aneurysms had reached 5 cm. No rupture occurred in aneurysms smaller than 5 cm in diameter. The cumulative incidence of probable rupture was significantly higher in the 5 cm-observation group than in the 4 cm-observaton group (p<0.0001). The cumulative 5-year survival rate of the early surgery group (77.8%) was significantly higher than that of the observation group (58.3%). However, the outcome in the 4 cm-observation group was almost same as in the early surgery group and the estimated prognosis curve of the Japanese normal population based on Life Table for Japan; therefore the outcome was significantly poorer in the 5 cm-observation group. The operative mortality rate was 0.6% in the patients who received elective surgery and there was no statistical significance in the cumulative survival rate after operation between the early surgery group and the additional elective surgery after observation (76.8% and 75.1% in 5-year survival rate, prospectively). There was also no statistical significance in the outcome after operation between the 4 cm-observation group and the 5 cm-observation group (74.8% and 78.6% in 5-year survival rate, prospectively). Conclusion: From our present study, it is valid that AAA smaller than 5 cm in diameter should be observed and followed up.

Journal

• Japanese Journal of Vascular Surgery

  Japanese Journal of Vascular Surgery 15 (1), 3-9, 2006

  JAPANESE SOCIETY FOR VASCULAR SURGERY

Keywords

• Abdominal aortic aneurysm
• Decision making
• Rupture
• Prognosis

Details

• CRID: 1390001204414019456
• NII Article ID: 10018363283
• NII Book ID: AN10399956
• DOI: 10.11401/jsvs.15.3
• ISSN: 1881767X
• ISSN: 09186778
• Web Site: https://search.jamas.or.jp/link/ui/2006112743
• Text Lang: ja
• Data Source:
  • JaLC
  • CiNii Articles
• Abstract License Flag: Disallowed