Outcome of early surgery compared to surveillance in the management of small aortic aneurysms--a comparative mortality analysis.

When underwriting individuals with aortic aneurysms, the following factors are used in risk selection: location, initial size, stability or velocity of change in size and co-morbid impairments. Treatment options based on clinical and ultrasonic findings are either surveillance or surgical resection. A recent study examined the 8-year outcome of early-surgery vs surveillance in small (4.6 cm) aortic aneurysms. Over the duration, the early-surgery group had a mortality ratio of 170% and excess death rate of 28; the surveillance group had a mortality ratio of 215% and excess death rate of 45. First-year mortality was expectedly high in the early-surgery group. Excluding first-year experience, the early-surgery group had an improved mortality ratio of 160% and excess death rate of 22. After 6 months, the death rate in the early-surgery group was about three fourths that of the surveillance group. However, due to high initial mortality cumulative survival curves did not cross in favor of early-surgery until about 3 years.