Published online before print June 21, 2004, doi: 10.1161/01.CIR.0000133279.07468.9F
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(Circulation. 2004;110:16-21.)
© 2004 American Heart Association, Inc.
Original Articles |
Abdominal Aortic Aneurysm Expansion
Risk Factors and Time Intervals for Surveillance
From the MRC Clinical Trials Unit (A.R.B.), London, UK; the MRC Biostatistics Unit (S.G.T.), Cambridge, UK; the Wolfson Unit for Prevention of Peripheral Vascular Diseases (F.G.R.F.), Public Health Sciences, Edinburgh University Medical School, Edinburgh, UK; and the Department of Vascular Surgery (R.M.G., J.T.P.), Imperial College at Charing Cross Hospital, London, UK.
Correspondence to Prof Janet Powell, Department of Vascular Surgery, Imperial College at Charing Cross Hospital, Fulham Palace Rd, London W6 8RF, UK. E-mail j.powell{at}imperial.ac.uk
Received December 8, 2003; de novo received January 26, 2004; accepted March 19, 2004.
Background— Intervention to reduce abdominal aortic aneurysm (AAA) expansion and optimization of screening intervals would improve current surveillance programs. The aim of this study was to characterize AAA growth in a national cohort of patients with AAA both overall and by cardiovascular risk factors.
Methods and Results— In this study, 1743 patients were monitored for changes in AAA diameter by ultrasonography over a mean follow-up of 1.9 years. Mean initial AAA diameter and growth rate were 43 mm (range 28 to 85 mm) and 2.6 mm/year (95% range, –1.0 to 6.1 mm/year), respectively. Baseline diameter was strongly associated with growth, suggesting that AAA growth accelerates as the aneurysm enlarges. AAA growth rate was lower in those with low ankle/brachial pressure index and diabetes but higher for current smokers (all P<0.001). No other factor (including lipids and blood pressure) was associated with AAA growth. Intervals of 36, 24, 12, and 3 months for aneurysms of 35, 40, 45, and 50 mm, respectively, would restrict the probability of breaching the 55-mm limit at rescreening to below 1%.
Conclusions— Annual, or less frequent, surveillance intervals are safe for all AAAs 
45 mm in diameter. Smoking increases AAA growth, but atherosclerosis plays a minor role.
Key Words: aneurysm • aorta • atherosclerosis • smoking
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