Outcome in patients with a large abdominal aortic aneurysm considered unfit for surgery.

Abstract

The risk of rupture of large abdominal aortic aneurysms (AAAs) remains uncertain. This study aimed to provide data to help decide whether or not to operate on high-risk patients. Clinicians were asked to refer all patients with an AAA, even if unfit or elderly. One hundred and ninety-two patients with an intact AAA of 5 cm or greater in diameter were seen in 9 years; 59 had no elective operation and follow-up data were available for 57 at a minimum of 2 years. Initial AAA diameters were 5.0-5-9 cm (n=25) and 6.0 cm or more (n=32). Survival curves were constructed for both groups. At the end of the study 50 of 57 patients had died. Median survival was 18 (range 1-90) months. Twenty (35 per cent) suffered rupture at a median interval of 18 (range 1-38) months. The risk of rupture within 3 years was 28 (95 per cent confidence interval 12-49) per cent for 5.0-5.9-cm AAAs and 41 (24-59) per cent for AAAs of 6 cm or greater. In 133 elective AAA operations in fit patients the 30-day mortality rate was 3 per cent. The risk of rupture within 3 years of diagnosis of an AAA of 5 cm or greater exceeds the expected operative mortality rate for fit patients. However, the majority of patients unfit for surgery died from other causes, and only a few would have benefited from aneurysm repair.