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

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.