IMPORTANCE: Small abdominal aortic aneurysms (AAAs [3.0 cm-5.4 cm in diameter]) are monitored by ultrasound surveillance. The intervals between surveillance scans should be chosen to detect an expanding aneurysm prior to rupture. OBJECTIVE: To limit risk of aneurysm rupture or excessive growth by optimizing ultrasound surveillance intervals. DATA SOURCES AND STUDY SELECTION: Individual patient data from studies of small AAA growth and rupture were assessed. Studies were identified for inclusion through a systematic literature search through December 2010. Study authors were contacted, which yielded 18 data sets providing repeated ultrasound measurements of AAA diameter over time in 15,471 patients. DATA EXTRACTION: AAA diameters were analyzed using a random-effects model that allowed for between-patient variability in size and growth rate. Rupture rates were analyzed by proportional hazards regression using the modeled AAA diameter as a time-varying covariate. Predictions of the risks of exceeding 5.5-cm diameter and of rupture within given time intervals were estimated and pooled across studies by random effects meta-analysis. RESULTS: AAA growth and rupture rates varied considerably across studies. For each 0.5-cm increase in AAA diameter, growth rates increased on average by 0.59 mm per year (95% CI, 0.51-0.66) and rupture rates increased by a factor of 1.91 (95% CI, 1.61-2.25). For example, to control the AAA growth risk in men of exceeding 5.5 cm to below 10%, on average, a 7.4-year surveillance interval (95% CI, 6.7-8.1) is sufficient for a 3.0-cm AAA, while an 8-month interval (95% CI, 7-10) is necessary for a 5.0-cm AAA. To control the risk of rupture in men to below 1%, the corresponding estimated surveillance intervals are 8.5 years (95% CI, 7.0-10.5) and 17 months (95% CI, 14-22). CONCLUSION AND RELEVANCE: In contrast to the commonly adopted surveillance intervals in current AAA screening programs, surveillance intervals of several years may be clinically acceptable for the majority of patients with small AAA.
IMPORTANCE: Small abdominal aortic aneurysms (AAAs [3.0 cm-5.4 cm in diameter]) are monitored by ultrasound surveillance. The intervals between surveillance scans should be chosen to detect an expanding aneurysm prior to rupture. OBJECTIVE: To limit risk of aneurysm rupture or excessive growth by optimizing ultrasound surveillance intervals. DATA SOURCES AND STUDY SELECTION: Individual patient data from studies of small AAA growth and rupture were assessed. Studies were identified for inclusion through a systematic literature search through December 2010. Study authors were contacted, which yielded 18 data sets providing repeated ultrasound measurements of AAA diameter over time in 15,471 patients. DATA EXTRACTION: AAA diameters were analyzed using a random-effects model that allowed for between-patient variability in size and growth rate. Rupture rates were analyzed by proportional hazards regression using the modeled AAA diameter as a time-varying covariate. Predictions of the risks of exceeding 5.5-cm diameter and of rupture within given time intervals were estimated and pooled across studies by random effects meta-analysis. RESULTS: AAA growth and rupture rates varied considerably across studies. For each 0.5-cm increase in AAA diameter, growth rates increased on average by 0.59 mm per year (95% CI, 0.51-0.66) and rupture rates increased by a factor of 1.91 (95% CI, 1.61-2.25). For example, to control the AAA growth risk in men of exceeding 5.5 cm to below 10%, on average, a 7.4-year surveillance interval (95% CI, 6.7-8.1) is sufficient for a 3.0-cm AAA, while an 8-month interval (95% CI, 7-10) is necessary for a 5.0-cm AAA. To control the risk of rupture in men to below 1%, the corresponding estimated surveillance intervals are 8.5 years (95% CI, 7.0-10.5) and 17 months (95% CI, 14-22). CONCLUSION AND RELEVANCE: In contrast to the commonly adopted surveillance intervals in current AAA screening programs, surveillance intervals of several years may be clinically acceptable for the majority of patients with small AAA.
Authors: Lu Yao; Aaron R Folsom; Alvaro Alonso; Pamela L Lutsey; James S Pankow; Weihua Guan; Susan Cheng; Frank A Lederle; Weihong Tang Journal: Atherosclerosis Date: 2018-02-04 Impact factor: 5.162
Authors: Kevin C Chun; Ashley S Schmidt; Sukhmine Bains; Anthony T Nguyen; Kiana M Samadzadeh; Machelle D Wilson; John H Peters; Eugene S Lee Journal: J Vasc Surg Date: 2015-10-21 Impact factor: 4.268
Authors: Elizabeth George; Andreas A Giannopoulos; Ayaz Aghayev; Saurabh Rohatgi; Amir Imanzadeh; Antonios P Antoniadis; Kanako K Kumamaru; Yiannis S Chatzizisis; Ruth Dunne; Michael Steigner; Michael Hanley; Edwin C Gravereaux; Frank J Rybicki; Dimitrios Mitsouras Journal: J Cardiovasc Comput Tomogr Date: 2015-12-02
Authors: Alexandra C Sundermann; Keith Saum; Kelsey A Conrad; Hannah M Russell; Todd L Edwards; Kevin Mani; Martin Björck; Anders Wanhainen; A Phillip Owens Journal: Blood Adv Date: 2018-11-27
Authors: Marc A Bailey; Paul D Baxter; Tao Jiang; Aimee M Charnell; Kathryn J Griffin; Anne B Johnson; Katherine I Bridge; Soroush Sohrabi; D Julian A Scott Journal: Aorta (Stamford) Date: 2013-12-01