Selective management of high risk patients with an abdominal aortic aneurysm.

One hundred and eighty-seven patients with abdominal aortic aneurysm seen during a 15 year period were denied operation at the time of initial evaluation because of the small size of the aneurysm or serious medical contraindications, or both. Seven patients were operated upon because of rupture, 16 because of symptomatic expansion, 13 because of increase in size to greater than 6 centimeters and six because of improvement in medical status. Operative related deaths occurred in five of the seven patients operated upon for rupture, four of the 16 patients operated upon because of symptomatic expansion and one of the 19 patients operated upon electively. Of the 153 patients selectively observed, 74 died during the follow-up period; 20 deaths were aneurysm related. while 54 deaths were due to associated disease. Sixteen of 18 patients with a rupture of the aneurysm died as a result. In the entire group of 187 patients, the cumulative survival rate was 44 per cent at five years and 27 per cent at ten years. Results of this study support the current management of high risk patients with abdominal aortic aneurysms but suggest that there is a need for an even more aggressive approach to patient selection.