EXPANSION PATTERN AND RISK OF RUPTURE OF ABDOMINAL AORTIC-ANEURYSMS THAT WERE NOT OPERATED ON

Objective: To analyse the outcome of selective management of patients with abdominal aortic aneurysms, the expansion patterns of the aneurys ms, and the factors that influenced the rate of rupture. Design: Retro spective study. Setting: Malmo General Hospital, Lund University, Malm o, Sweden. Subjects: 155 patients (96 men and 59 women) with abdominal aortic aneurysms who were not selected for operation for whatever rea son were included in the study immediately after their first ultrasoun d scan. Main outcome measures: Mortality, expansion rate (mm/year) mea sured on ultrasound scan. and rate of rupture of aneurysm. Results: Me dian aneurysmal diameter was 40 mm (range 20-80), and length (n = 106) 70 (range 28-140). The patients were followed up for a median of 3.4 years (range 0-10.2). A total of 107 patients died and in 21 the aneur ysms ruptured (4 were operated on and survived). Thirteen patients wer e re-evaluated and operated on electively. Ultrasonography was repeate d in 98 patients, the median expansion rates (mm/year) were 3.1 (diame ter) and 1.9 (length). There was a significant linear relationship bet ween initial size (diameter and length) and rate of expansion of diame ter. The risk of rupture was greater in larger aneurysms that were exp anding more quickly. The cumulative mortality was not affected by the 21 aneurysms that ruptured. Conclusion: Selective management of patien ts with aortic aneurysms is justified.