This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Meta‐analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms. BJS 2012; 99: 655-665.
Published: 5th March 2012
Authors: M. J. Sweeting, S. G. Thompson, L. C. Brown, J. T. Powell
Background
Surveillance is a common management strategy for small abdominal aortic aneurysm (AAA) (3·0–5·4 cm in diameter). Individual characteristics, other than diameter, may influence aneurysm growth or rupture rates.
Method
Individual data were collated from 15 475 people under follow‐up for a small aneurysm in 18 studies. The influence of co‐variables (including demographics, medical and drug history) on aneurysm growth and rupture rates (analysed using longitudinal random‐effects modelling and survival analysis with adjustment for aneurysm diameter) were summarized in an individual patient meta‐analysis.
Results
The mean aneurysm growth rate of 2·21 mm/year was independent of age and sex. Growth rate was increased in smokers (by 0·35 mm/year) and decreased in patients with diabetes (by 0·51 mm/year). Mean arterial pressure had no effect and antihypertensive or other cardioprotective medications had only small, non‐significant effects on aneurysm growth, consistent with the observation that calendar year of enrolment was not associated with growth rate. Rupture rates were almost fourfold higher in women than men (P < 0·001), were double in current smokers (P = 0·001) and increased with higher blood pressure (P = 0·001).
Conclusion
Follow‐up schedules for individuals with a small AAA may need to consider diabetes and smoking, in addition to aneurysm diameter. The differing risk factors for growth and rupture suggest that a lower threshold for surgical intervention in women may be justified. No single drug used for cardiovascular risk reduction had a major effect on the growth or rupture of small aneurysms. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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