Small Abdominal Aortic Aneurysms Under Surveillance in the Over 80s: A Step Too Far?

There remains limited evidence regarding surveillance and management of small abdominal aortic aneurysm (AAA) (males <5.5 cm women <5.0 cm) within those ≥80 years age. This review offers a unique experience 17 analysis single consultant practice in stable population (350,000), on AAA at typical District General Hospital the UK, prompted by current suggestions to consider discontinuing ≥85 age with AAA. Retrospective prospectively collected data all patients referred followed up over year period (2006 January 2023). study is subgroup analysis, age, or who became so during follow-up. Only for men index scan were included. Analysis was stratified according size time referral: < 4, 4-5, >5 <3.5, 3.5-4.5, cm.Outcomes assessed all-cause mortality, rupture, increment that reached threshold management, including treatment type. From 314 patients, 144 aged referral this (76% male, mean 81 years; range, 74-96 follow-up mean, 47.9 ± 129 months), average diameter 4.00 0.67 cm. Of 70.1% (n = 101) never intervention (23 female, 78 male); 43 did, 22 underwent elective intervention, 19 endovascular repair (2 complex) 2 open. Two emergency interventions carried out (1 1 open). In only 34.9% remain alive 2023. Among males an <4 54) review, 7 went reach (P .001) rupture. females <3.5 aorta 10), 0 ruptured (Table). Overall, 69.4% died, 4.9% 7) rupture 43.1% having cancer diagnosis Our consistent UK Small Aneurysm Trial, which showed 12-year mortality 63.9% surgery 67.3% groups. >80 have there low chance these will ever lead These suggest could be safely discontinued if criteria are met.TableOutcomes from scanAneurysm (cm)No. (%)Reached (% total)P valueaIntervention total)Rupture total)Median follow-up, months (interquartile range)Male <4.054 (49.1)7 (12.9)<.00016 (11.1)1 (1.9)61 (25-91) 4.0-5.041 (37.3)19 (46.3)9 (22.0)2 (4.9)41 (16-72) >5.015 (13.6)6 (40.0)6 (40.0)1 (6.7)18 (6-25)Female <3.510 (29.4)0 (0.0)<.00010 (0.0)0 (0.0)50 (9-61) 3.5-4.519 (55.9)7 (36.8)2 (10.5)2 (10.5)47 (7-80) >4.55 (14.7)4 (80.0)0 (0.0)1 (20.0)40 (12-39)a χ2 test. Open table new tab