At What Size Does An Aortic Aneurysm Rupture?

Journal of Vascular Surgery

Presented at the 40-first Annual Symposium of the Society for Clinical Vascular Surgery, Miami, Fla, March 12-16, 2013.

Objective

Women have been shown to have up to a fourfold higher gamble of abdominal aortic aneurysm (AAA) rupture at whatsoever given aneurysm diameter compared with men, leading to recommendations to offer repair to women at lower diameter thresholds. Although this higher risk of rupture may simply reflect greater relative aortic dilatation in women who take smaller aortas to brainstorm with, this has never been quantified. Our objective was therefore to quantify the relationship between rupture and aneurysm diameter relative to body size and determine whether a differential association between aneurysm diameter, body size, and rupture risk exists for men and women.

Methods

We performed a retrospective review of all patients in the Vascular Written report Group of New England (VSGNE) database who underwent endovascular or open AAA repair. Height and weight were used to calculate each patient's body mass index and body expanse (BSA). Next, indices of each mensurate of body size (meridian, weight, body mass index, BSA) relative to aneurysm diameter were calculated for each patient. To generate these indices, we divided aneurysm diameter (in cm) past the measure of body size; for example, aortic size index (ASI) = aneurysm diameter (cm)/BSA (m²). Along with other relevant clinical variables, we used these indices to construct unlike age-adjusted and multivariable-adjusted logistic regression models to determine predictors of ruptured repair vs elective repair. Models for men and women were developed separately, and different models were compared using the area under the curve.

Results

Nosotros identified 4045 patients (78% male) who underwent AAA repair (53% endovascular aortic aneurysm repairs). Women had significantly smaller diameter aneurysms, lower BSA, and higher BSA indices than men. For men, the variable that increased the odds of rupture the most was aneurysm diameter (surface area under the curve = 0.82). Men exhibited an increased rupture risk with increasing aneurysm bore (<5.v cm: odds ratio [OR], 1.0; five.5-6.4 cm: OR, 0.9; 95% confidence interval [CI], 0.5-1.7; P = .771; six.five-7.4 cm: OR, 3.9; 95% CI, 1.9-1.0; P < .001; ≥7.5 cm: OR, xi.3; 95% CI, 4.ix-25.viii; P < .001). In contrast, the variable most predictive of rupture in women was ASI (area under the curve = 0.81), with higher odds of rupture at a college ASI (ASI >3.v-three.9: OR, 6.4; 95% CI, ane.vii-24.one; P = .006; ASI ≥4.0: OR, ix.5; 95% CI, two.3-39.4; P = .002). For women, aneurysm bore was not a significant predictor of rupture after adjusting for ASI.

Conclusions

Aneurysm diameter indexed to trunk size is the about important determinant of rupture for women, whereas aneurysm diameter solitary is most predictive of rupture for men. Women with the largest bore aneurysms and the smallest body sizes are at the greatest hazard of rupture.

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