The management of abdominal aortic aneurysms

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d1384 (Published 10 March 2011)
Cite this as: BMJ 2011;342:d1384

This article has a correction

Please see: The management of abdominal aortic aneurysms

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  1. David Metcalfe, honorary research fellow1,
  2. Peter J E Holt, clinical lecturer in vascular surgery and outcomes research1,
  3. Matt M Thompson, professor of vascular surgery 1
  1. 1Department of Outcomes Research, St George’s Vascular Institute, St George’s Healthcare NHS Trust, London SW17 0QT, UK
  1. Correspondence to: PJE Holt pholt{at}sgul.ac.uk
  • Accepted 8 February 2011

Summary points

  • The UK screening programme for abdominal aortic aneurysms (AAAs) will screen all men aged 65 to facilitate surveillance for small aneurysms or operative repair for large ones

  • Ultrasound surveillance for small aneurysms (<5.5 cm) is safe and cost effective

  • All patients with AAAs have a high cardiovascular risk and warrant aggressive risk factor management, including smoking cessation

  • The risk of aneurysm rupture outweighs that of postoperative morbidity and mortality for aneurysms >5.5 cm in patients with reasonable comorbidity

  • Definitive management requires operative repair; endovascular (in morphologically suitable aneurysms) repair is associated with lower early and midterm mortality than open repair

  • Surgical repair should be performed in high volume centres by experienced practitioners providing endovascular and open repair

An abdominal aortic aneurysm (AAA) is a permanent dilation of the abdominal aorta greater than 3 cm in diameter (fig 1). The natural course is one of progressive enlargement, and maximum aortic diameter is the strongest predictor of aneurysm rupture.1 w1 w2 The reported incidence of AAA is 4.9-9.9%,2 3 4 and mortality after rupture exceeds 80%, accounting for 8000 deaths annually in the United Kingdom.5 w3 Elective surgical repair has an operative mortality of 1-5% in the best centres,5 6 and several countries have implemented population screening programmes to reduce aneurysm related mortality.

Fig 1 Preoperative computed tomography reconstruction of a 7.4 cm infrarenal abdominal aortic aneurysm

This review considers the epidemiology and management of AAA using evidence from population studies, randomised controlled trials, meta-analyses, and published guidelines.

Sources and selection criteria

We searched PubMed for “abdominal aortic aneurysm” or “AAA” and used reference lists to identify key studies. We also consulted the Cochrane Library and consensus guidelines. The evidence base informing management of abdominal aortic aneurysms is relatively strong and we gave priority to large well designed randomised controlled trials, …

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