Perspectives,personal experiences and personalized threshold for intervention in abdominal aortic aneurysm

Background

Current threshold for intervention for ubiquitous abdominal aortic aneurysm of 5.5 cm may not be one size fits all on a global perspective. We analysed long-term results with open repair of abdominal aortic aneurysm and postulated to provide proof of concept for personalized threshold, globally applicable for abdominal aortic aneurysm.

Methods

From 1998 to date, open conventional repair of abdominal aortic aneurysms performed in 274 consecutive patients, with 214 elective and 60 emergent, formed basis of this report. Thirty-two of the elective procedures were performed for small aneurysms of 4–5.4 cm. Concurrently, body weight and height were recorded in 100 patients undergoing computed tomography of abdomen for non-vascular reasons and 32 patients with small aneurysm who underwent elective repair. Aortic diameter was measured at predetermined domains of infrarenal aorta.

Results

Thirty-day mortality for elective and emergent groups was 3.73 and 28 %, respectively. Aortic diameter ranged from 1.4 to 1.8 cm and calculated body surface area from 1.44 to 1.7 m². Normal aortic size, with proven relationship to body surface area, becomes aneurismal when >150 % times its size. Threshold diameter of 5.5 cm has ingrained ‘defining number 3’ considering body surface area in Western males of ≥1.8 m² (5.5?÷?1.8?=?3).

Conclusion

Elective repair of abdominal aortic aneurysm is safe, durable with low reintervention rates and easy surveillance protocol. Body surface area, calculated using Mosteller formula from individual’s height and weight, multiplied by threshold factor ‘3’ to determine personalized threshold, so optimal size and time to intervene, in patients with small aneurysm, is at best proof of concept applicable to Indian and Asian populations.