Breakfast Debate: Management of Small Abdominal Aortic Aneurysms

Abstract

-Controversy over optimal management of small abdominal aortic aneurysms (AAAs) continues, and in this debate three expert panelists present convincing data to support different management strategies: observation, open surgical repair, and endovascular treatment. Recently published data of a multicenter study from the United Kingdom and preliminary information available on the ADAM (Aneurysm Detection And Management) study suggest that close observation and regular follow-up with ultrasound is safe. Rupture rate of small aneurysms (< 5.5 cm) in these studies did not exceed 1% per year. Proponents of surgical treatment argue that small aneurysms increase in size in half of the patients within 3 years and then older patients with higher risk will undergo surgical treatment, leading to elevated morbidity and mortality. If the surgeon has documented low mortality rate, the patient is low risk, and has a long life expectancy, then repair of small aneurysms appears to be justified. Patient preference, however, is becoming increasingly important, and even younger, good-risk patients may decide on endovascular treatment, in spite of the need for regular surveillance and the lack of data on long-term complications following aortic stent-graft placement. There is no consensus on optimal management of small AAAs, although the correct question may not be if patients with small AAAs should undergo repair but when should they undergo repair using either open or endovascular techniques.