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FOLLOWING ABDOMINAL AORTIC ANEURYSMS BY ULTRASOUND.

Most studies describing the risk for rupture for abdominal aortic aneurysm (AAA) rely on measurements of diameter taken at symptom presentation rather than after the most recent ultrasound. This study from the Mayo Clinic used data taken at "last ultrasound" to describe growth rates and outcomes of AAAs for a defined patient population in Rochester, Minnesota.

Researchers followed 176 patients (average age, 74 years) with known, unruptured AAAs for an average of about five years; the average number of ultrasounds performed per patient was 2.5. During follow-up, 82 patients underwent elective AAA surgery, 11 experienced rupture (four underwent emergency surgery), and 97 died of causes other than ruptured AAA. No AAA less than 4 cm in diameter on last ultrasound ruptured. The rupture risk was 1.0 percent per year for AAAs between 4 and 5 cm, and 11 percent per year for AAAs between 5 and 6 cm.

Comment: This longitudinal, population-based study provides extremely helpful guidance to primary care physicians confronted with an expanding AAA. Prior studies that evaluated risk using aneurysm size at diagnosis tended to overestimate rupture risk at diameters less than 5 cm. The authors recommend annual follow-up ultrasounds for AAAs less than 4 cm, and six-month follow-up for AAAs between 4 and 5 cm.

— TL Schwenk

Published in Journal Watch General Medicine October 21, 1997

Citation(s):

Reed WW et al. Learning from the last ultrasound: A population-based study of patients with abdominal aortic aneurysm. Arch Intern Med 1997 Oct 13 157 2064-2068.

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