Five-Year Natural History of Screening Detected Sub-Aneurysms and Abdominal Aortic Aneurysms in 70-Year-Old Women and Systematic Review of Repair Rate in Women

Abstract

Introduction - The aim of this study was to report on the natural history of a population-based cohort of 70-year old women with screening-detected infra-renal abdominal aortic aneurysms or sub-aneurysms as well as to systematically review publications reporting the rate of infra-renal intact aneurysm repair in women. Methods - In a previous study1, 5140 (74%) of 6925 invited women attended an ultrasound (US) examination of the abdominal aorta at age 70 years. All 52 women with screening detected sub-aneurysms (SA, diameter 25-29mm) and abdominal aortic aneurysms (AAA, diameter ≥30mm), were followed for 5 years with ultrasound. Infrarenal aortic diameters, AAA repair, all-cause and AAA-specific mortality, and risk factors were recorded. In addition, a systematic review of the rate of infra-renal intact aneurysm repair in women was conducted. Results - Sub-aneurysm A total of 33 (0.6%) women had a SA at the age of 70 and after five years follow-up two (6%) declined follow-up, five (15%) had died, and 26 were re-examined at age 75. 12/26 (46%) had progressed to AAAs from SAs and one woman was directly qualified for surgery. Smoking (p=0.010) and aortic diameter (p=0.040) were associated with progression to AAA. Aortic Abdominal Aneurysm A total of 19 (0.4%) women had an AAA at the age 70. After 5 years follow-up two (11%) had died, six (32%) had been electively repaired with no 30-day mortality, and 11 (58%) had an AAA still under surveillance at age 75 years. Systematic review In the systematic search four studies2-5 were identified and data on natural history was extracted and reviewed. A total of 842 women, with a mean aortic diameter of 26-39 mm at start of surveillance, were identified with a mean age of 70-75 years. After a follow-up of 2.5-10 years the elective repair rate was 3-25%. Data on rupture rate and all-cause mortality was scarce. Conclusion - Screening-detected AAAs and sub-aneurysms are clinically relevant in women. Within five years of detection a high proportion of AAAs require elective surgery, and a high proportion of sub-aneurysms progress to AAAs. Consequently, surveillance of sub-aneurysms in women with reasonable life-expectancy can be considered. Publications on repair-rate in women with intact AAAs are scarce and heterogeneous.