Vascular Surgery Consultant Wirral University Teaching Hospital Wirral, England, United Kingdom
Objectives: There remains limited evidence regarding surveillance and management of small AAA (males < 5.5cm & women < 5.0cm) within those ≥80 years of age.
This review offers a unique experience of a 17 years analysis of a single consultant practice in a stable population (350,000), on management of small AAA at a typical District General Hospital in the United Kingdom, prompted by current suggestions to consider discontinuing surveillance in those ≥85 years of age with small AAA.
Methods: Retrospective review of prospectively collected data of all patients referred and followed up with small AAA over a 17 year period (2006 – January 2023).
This study is a subgroup analysis, in those ≥80 years of age, or who became so during follow up. Only those with AAA < 5.5 cm for men and < 5.0 cm for women at index scan were included.
Analysis was stratified according to size of AAA at the time of referral: Men AAA < 4, 4-5 and >5cm and women < 3.5, 3.5-4.5 and >5cm.Outcomes were assessed for all-cause mortality, AAA rupture, size increment and those that reached threshold for management, including treatment type.
Results: From 314 patients, 144 were aged ≥80 at referral or reached this during surveillance (76% male, mean age 81 years (range 74-96) & follow up mean 47.9 months (SD 129)), average AAA diameter of 4cm (SD 0.67).
70.1% (n=101) never reached threshold for intervention (23 female, 78 male). 43 that did, 22 underwent elective intervention; 19 EVAR (2 complex) and 2 open. 2 emergency interventions were carried out (1 EVAR and 1 open). In those that underwent intervention only 34.9% remain alive in January 2023.
Males with AAA < 4cm (n=54) at index review: 7 went on to reach threshold for intervention (P <.001) with only 1 rupture.
Females with < 3.5cm aorta at index review (n=10): 0 reached threshold (P <.001) nor ruptured (Table I).
69.4% patients died, 4.9% (n=7) of rupture, with 43.1% having a cancer diagnosis during follow up.
Conclusions: Our study is consistent with the UK Small Aneurysm Trial, which showed 12 year mortality of 63.9% in surgery and 67.3% in the surveillance groups.
In those over 80 who have a AAA < 4cm in men and < 3.5cm women at index review, there is a low chance that these will ever reach threshold or lead to rupture. This data suggests that surveillance could be safely discontinued if this criteria is met.