A study of outcomes in conservatively managed patients with large abdominal aortic aneurysms deemed unfit for surgical repair

Vascular. 2019 Apr;27(2):161-167. doi: 10.1177/1708538118807075. Epub 2018 Oct 14.

Abstract

Background: The current advancement and increasing use of diagnostic imaging has led to increased detection of abdominal aortic aneurysms (AAA). Many of these patients are unfit for elective AAA surgery.

Aim: To investigate the outcome of conservative management of unfit patients with large AAA (>5.5 cm) who are turned down for elective surgical intervention.

Patients and methods: Between January 2006 and April 2017, 457 patients presented with AAA >5.5 cm. Seventy-six patients (M: F 54:22) were deemed unfit for elective repair. Mean age was 79.8 years (range 64-96). Mean AAA size was 60.22 mm (55-83).

Results: Forty-nine of the 76 patients (64%) had died by April 2017. Fifteen (19.7%) patients died directly because of their aneurysm rupture. A further 34 (44.7%) patients died from non-aneurysm-related causes.

Conclusion: Patients with large AAA deemed unfit for elective surgery have an overall poor prognosis and die mainly from other causes than AAA. Surgical intervention when rupture occurs results in poor survival.

Keywords: Abdominal aortic aneurysm; unfit large abdominal aortic aneurysm.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm, Abdominal / complications
  • Aortic Aneurysm, Abdominal / diagnostic imaging
  • Aortic Aneurysm, Abdominal / mortality
  • Aortic Aneurysm, Abdominal / therapy*
  • Aortic Rupture / etiology
  • Aortic Rupture / mortality
  • Aortography / methods
  • Cause of Death
  • Computed Tomography Angiography
  • Conservative Treatment / adverse effects
  • Conservative Treatment / methods*
  • Contraindications, Procedure
  • Databases, Factual
  • Elective Surgical Procedures
  • Female
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Vascular Surgical Procedures / adverse effects*