Editor's Choice - Risk of Rupture and All Cause Mortality of Abdominal Aortic Ectasia: A Systematic Review and Meta-Analysis

Takuro Shirasu; Hisato Takagi; Toshiki Kuno; Jun Yasuhara; Kenneth Craig Kent; Margaret C Tracci; William Darrin Clouse; Behzad S Farivar

doi:10.1016/j.ejvs.2022.05.005

Editor's Choice - Risk of Rupture and All Cause Mortality of Abdominal Aortic Ectasia: A Systematic Review and Meta-Analysis

Eur J Vasc Endovasc Surg. 2022 Jul;64(1):15-22. doi: 10.1016/j.ejvs.2022.05.005. Epub 2022 May 7.

Authors

Takuro Shirasu¹, Hisato Takagi², Toshiki Kuno³, Jun Yasuhara⁴, Kenneth Craig Kent⁵, Margaret C Tracci⁵, William Darrin Clouse⁵, Behzad S Farivar⁵

Affiliations

¹ Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, USA; Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, VA, USA. Electronic address: shirasu-tky@umin.ac.jp.
² Department of Cardiovascular Surgery, Shizuoka Medical Centre, Shizuoka, Japan.
³ Department of Cardiology, Montefiore Medical Centre, Albert Einstein Medical College, New York, NY, USA.
⁴ Centre for Cardiovascular Research, The Abigail Wexner Research Institute and The Heart Centre, Nationwide Children's Hospital, Columbus, OH, USA.
⁵ Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, USA; Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, VA, USA.

PMID: 35537643
DOI: 10.1016/j.ejvs.2022.05.005

Abstract

Objective: To clarify the natural history of abdominal aortic ectasia (AAE) measuring 25 - 29 mm in maximum diameter, and to determine the optimal follow up based on the growth, risk of rupture, and overall mortality of AAE.

Data sources: MEDLINE, Web of Science Core Collection, and Google Scholar.

Review methods: This was a systematic review and meta-analysis of AAE in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Web of Science Core Collection, and Google Scholar were searched, with the help of a health sciences librarian, up to 11 August 2021. Studies with longitudinal outcomes of AAE (prevalence, annual growth rate, aneurysmal enlargement, rupture, aneurysm related death, and all cause mortality) were included. Meta-analyses were conducted with a random effects model RESULTS: Twelve studies describing a total of 8 369 patients were eligible. The prevalence at population based settings was 3.2% (95% confidence interval [CI] 2.4 - 4.0); annual growth rate was 0.82 mm/year (95% CI 0.20 - 1.45). The estimated risks of aortic diameters exceeding 30 mm and 55 mm in five years were 45.0% (95% CI 28.5 - 61.5) and 0.3% (95% CI 0 - 0.6) respectively, while those beyond five years were 70.2% (95% CI 46.9 - 93.6) and 5.2% (95% CI 2.2 - 8.2). The rates of rupture and aneurysm related death were minimal until five years (0.1% and 0.1%, respectively) and beyond (0.4% and 0.2%, respectively). Overall mortality was 7.5% (95% CI 3.9 - 11.0) and 17.3% (95% CI 9.5 - 25.1) up to and beyond five years. Overall mortality from three studies showed no statistical difference between AAE and aneurysms (hazard ratio 0.62, 95% CI 0.32 - 1.21; p = .16). Cancer (35.0%) and cardiovascular diseases (31.9%) were major causes of death.

Conclusion: AAE carries minimal risk of aneurysm related lethal events during the first five years, but a similar overall mortality risk as abdominal aortic aneurysm. Cancer and cardiovascular diseases are leading causes of death in patients with AAE.

Keywords: Abdominal aortic aneurysm; Abdominal aortic ectasia; Follow up; Meta-analysis; Mortality; Rupture.

Publication types

Review