Immediate repair compared with surveillance of small abdominal aortic aneurysms

Frank A. Lederle, Samuel E. Wilson, Gary R. Johnson, Donovan B. Reinke, Fred N. Littooy, Charles W. Acher, David J. Ballard, Louis M. Messina, Ian L. Gordon, Edmund P. Chute, William C. Krupski, Steven J. Busuttil, Gary W. Barone, Steven Sparks, Linda M. Graham, Joseph H. Rapp, Michel S. Makaroun, Gregory L. Moneta, Robert A. Cambria, Raymond G. Makhoul & 4 others Darwin Eton, Howard J. Ansel, Julie A. Freischlag, Dennis Bandyk

Research output: Contribution to journalArticle

Abstract

Background: Whether elective surgical repair of small abdominal aortic aneurysms improves survival remains controversial. Methods: We randomly assigned patients 50 to 79 years old with abdominal aortic aneurysms of 4.0 to 5.4 cm in diameter who did not have high surgical risk to undergo immediate open surgical repair of the aneurysm or to undergo surveillance by means of ultrasonography or computed tomography every six months with repair reserved for aneurysms that became symptomatic or enlarged to 5.5 cm. Follow-up ranged from 3.5 to 8.0 years (mean, 4.9). Results: A total of 569 patients were randomly assigned to immediate repair and 567 to surveillance. By the end of the study, aneurysm repair had been performed in 92.6 percent of the patients in the immediate-repair group and 61.6 percent of those in the surveillance group. The rate of death from any cause, the primary outcome, was not significantly different in the two groups (relative risk in the immediate-repair group as compared with the surveillance group, 1.21; 95 percent confidence interval, 0.95 to 1.54). Trends in survival did not favor immediate repair in any of the prespecified subgroups defined by age or diameter of aneurysm at entry. These findings were obtained despite a low total operative mortality of 2.7 percent in the immediate-repair group. There was also no reduction in the rate of death related to abdominal aortic aneurysm in the immediate-repair group (3.0 percent) as compared with the surveillance group (2.6 percent). Eleven patients in the surveillance group had rupture of abdominal aortic aneurysms (0.6 percent per year), resulting in seven deaths. The rate of hospitalization related to abdominal aortic aneurysm was 39 percent lower in the surveillance group. Conclusions: Survival is not improved by elective repair of abdominal aortic aneurysms smaller than 5.5 cm, even when operative mortality is low.

Original languageEnglish (US)
Pages (from-to)1437-1444
Number of pages8
JournalNew England Journal of Medicine
Volume346
Issue number19
DOIs
StatePublished - May 9 2002
Externally publishedYes

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Abdominal Aortic Aneurysm
Aneurysm
Mortality
Survival
Rupture
Cause of Death
Ultrasonography
Hospitalization
Tomography
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Lederle, F. A., Wilson, S. E., Johnson, G. R., Reinke, D. B., Littooy, F. N., Acher, C. W., ... Bandyk, D. (2002). Immediate repair compared with surveillance of small abdominal aortic aneurysms. New England Journal of Medicine, 346(19), 1437-1444. https://doi.org/10.1056/NEJMoa012573

Immediate repair compared with surveillance of small abdominal aortic aneurysms. / Lederle, Frank A.; Wilson, Samuel E.; Johnson, Gary R.; Reinke, Donovan B.; Littooy, Fred N.; Acher, Charles W.; Ballard, David J.; Messina, Louis M.; Gordon, Ian L.; Chute, Edmund P.; Krupski, William C.; Busuttil, Steven J.; Barone, Gary W.; Sparks, Steven; Graham, Linda M.; Rapp, Joseph H.; Makaroun, Michel S.; Moneta, Gregory L.; Cambria, Robert A.; Makhoul, Raymond G.; Eton, Darwin; Ansel, Howard J.; Freischlag, Julie A.; Bandyk, Dennis.

In: New England Journal of Medicine, Vol. 346, No. 19, 09.05.2002, p. 1437-1444.

Research output: Contribution to journalArticle

Lederle, FA, Wilson, SE, Johnson, GR, Reinke, DB, Littooy, FN, Acher, CW, Ballard, DJ, Messina, LM, Gordon, IL, Chute, EP, Krupski, WC, Busuttil, SJ, Barone, GW, Sparks, S, Graham, LM, Rapp, JH, Makaroun, MS, Moneta, GL, Cambria, RA, Makhoul, RG, Eton, D, Ansel, HJ, Freischlag, JA & Bandyk, D 2002, 'Immediate repair compared with surveillance of small abdominal aortic aneurysms', New England Journal of Medicine, vol. 346, no. 19, pp. 1437-1444. https://doi.org/10.1056/NEJMoa012573
Lederle FA, Wilson SE, Johnson GR, Reinke DB, Littooy FN, Acher CW et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. New England Journal of Medicine. 2002 May 9;346(19):1437-1444. https://doi.org/10.1056/NEJMoa012573
Lederle, Frank A. ; Wilson, Samuel E. ; Johnson, Gary R. ; Reinke, Donovan B. ; Littooy, Fred N. ; Acher, Charles W. ; Ballard, David J. ; Messina, Louis M. ; Gordon, Ian L. ; Chute, Edmund P. ; Krupski, William C. ; Busuttil, Steven J. ; Barone, Gary W. ; Sparks, Steven ; Graham, Linda M. ; Rapp, Joseph H. ; Makaroun, Michel S. ; Moneta, Gregory L. ; Cambria, Robert A. ; Makhoul, Raymond G. ; Eton, Darwin ; Ansel, Howard J. ; Freischlag, Julie A. ; Bandyk, Dennis. / Immediate repair compared with surveillance of small abdominal aortic aneurysms. In: New England Journal of Medicine. 2002 ; Vol. 346, No. 19. pp. 1437-1444.
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abstract = "Background: Whether elective surgical repair of small abdominal aortic aneurysms improves survival remains controversial. Methods: We randomly assigned patients 50 to 79 years old with abdominal aortic aneurysms of 4.0 to 5.4 cm in diameter who did not have high surgical risk to undergo immediate open surgical repair of the aneurysm or to undergo surveillance by means of ultrasonography or computed tomography every six months with repair reserved for aneurysms that became symptomatic or enlarged to 5.5 cm. Follow-up ranged from 3.5 to 8.0 years (mean, 4.9). Results: A total of 569 patients were randomly assigned to immediate repair and 567 to surveillance. By the end of the study, aneurysm repair had been performed in 92.6 percent of the patients in the immediate-repair group and 61.6 percent of those in the surveillance group. The rate of death from any cause, the primary outcome, was not significantly different in the two groups (relative risk in the immediate-repair group as compared with the surveillance group, 1.21; 95 percent confidence interval, 0.95 to 1.54). Trends in survival did not favor immediate repair in any of the prespecified subgroups defined by age or diameter of aneurysm at entry. These findings were obtained despite a low total operative mortality of 2.7 percent in the immediate-repair group. There was also no reduction in the rate of death related to abdominal aortic aneurysm in the immediate-repair group (3.0 percent) as compared with the surveillance group (2.6 percent). Eleven patients in the surveillance group had rupture of abdominal aortic aneurysms (0.6 percent per year), resulting in seven deaths. The rate of hospitalization related to abdominal aortic aneurysm was 39 percent lower in the surveillance group. Conclusions: Survival is not improved by elective repair of abdominal aortic aneurysms smaller than 5.5 cm, even when operative mortality is low.",
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T1 - Immediate repair compared with surveillance of small abdominal aortic aneurysms

AU - Lederle, Frank A.

AU - Wilson, Samuel E.

AU - Johnson, Gary R.

AU - Reinke, Donovan B.

AU - Littooy, Fred N.

AU - Acher, Charles W.

AU - Ballard, David J.

AU - Messina, Louis M.

AU - Gordon, Ian L.

AU - Chute, Edmund P.

AU - Krupski, William C.

AU - Busuttil, Steven J.

AU - Barone, Gary W.

AU - Sparks, Steven

AU - Graham, Linda M.

AU - Rapp, Joseph H.

AU - Makaroun, Michel S.

AU - Moneta, Gregory L.

AU - Cambria, Robert A.

AU - Makhoul, Raymond G.

AU - Eton, Darwin

AU - Ansel, Howard J.

AU - Freischlag, Julie A.

AU - Bandyk, Dennis

PY - 2002/5/9

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N2 - Background: Whether elective surgical repair of small abdominal aortic aneurysms improves survival remains controversial. Methods: We randomly assigned patients 50 to 79 years old with abdominal aortic aneurysms of 4.0 to 5.4 cm in diameter who did not have high surgical risk to undergo immediate open surgical repair of the aneurysm or to undergo surveillance by means of ultrasonography or computed tomography every six months with repair reserved for aneurysms that became symptomatic or enlarged to 5.5 cm. Follow-up ranged from 3.5 to 8.0 years (mean, 4.9). Results: A total of 569 patients were randomly assigned to immediate repair and 567 to surveillance. By the end of the study, aneurysm repair had been performed in 92.6 percent of the patients in the immediate-repair group and 61.6 percent of those in the surveillance group. The rate of death from any cause, the primary outcome, was not significantly different in the two groups (relative risk in the immediate-repair group as compared with the surveillance group, 1.21; 95 percent confidence interval, 0.95 to 1.54). Trends in survival did not favor immediate repair in any of the prespecified subgroups defined by age or diameter of aneurysm at entry. These findings were obtained despite a low total operative mortality of 2.7 percent in the immediate-repair group. There was also no reduction in the rate of death related to abdominal aortic aneurysm in the immediate-repair group (3.0 percent) as compared with the surveillance group (2.6 percent). Eleven patients in the surveillance group had rupture of abdominal aortic aneurysms (0.6 percent per year), resulting in seven deaths. The rate of hospitalization related to abdominal aortic aneurysm was 39 percent lower in the surveillance group. Conclusions: Survival is not improved by elective repair of abdominal aortic aneurysms smaller than 5.5 cm, even when operative mortality is low.

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