INFLUENCE OF SELECTIVE MANAGEMENT ON THE PROGNOSIS AND THE RISK OF RUPTURE OF ABDOMINAL AORTIC-ANEURYSMS

A total of 199 patients with abdominal aortic aneurysms were followed up to investigate the influence of selective management on the prognos is and the risk rupture of abdominal aortic aneurysms. Decisions to op erate or to continue watchful waiting with treatment of risk factors f or expansion were based on aneurysm size, expansion rate, aneurysm-rel ated symptoms, and individual operative risk. Rupture occurred in eigh t cases. All aneurysms were larger than 5 cm, and six were larger than 6 cm in diameter at the last measurement before rupture. The resultin g overall 5-year cumulative rate of rupture was 7.3% (Kaplan Meier). T he 134 patients who underwent more than one ultrasound examination wer e observed for an average of 4.0 years (536 patient-years). The expans ion rate was significantly correlated with the initial diameter and th e diastolic blood pressure (best subset multiple regression analysis: r = 0.403; P < 0.001). A correlation with the systolic blood pressure was found only in univariate analysis (r = 0.236; P = 0.011). Amplitud e of blood pressure, serum cholesterol level, low-density and high-den sity lipoproteins, ratio of low- to high-density lipoproteins age, and the extent of smoking habits were not correlated with the expansion r ate. Our conclusion is that larger diameter and higher diastolic blood pressure are important risk factors for expansion of abdominal aortic aneurysms. Selective management of abdominal aortic aneurysms based o n aneurysmal size, expansion rate, and patient characteristics may res ult in a low rate of rupture.