DOCTOR'S VIEW ARCHIVE
An aneurysm is a swelling of an artery due to weakness in the vessel wall. It is a common cause of sudden death and often provides no warning signs or symptoms.
Currently, the only method to prevent rupture of an aneurysm is surgical repair of the vessel. But, because of the risks involved in surgery, the aneurysm is generally allowed to reach a size for which the risk of rupture outweighs the risk of surgery.
Is it safe to monitor an abdominal aneurysm rather than have surgery right away? A report in the medical journal The Lancet on November 21, 1998 bears upon this potentially life-and-death decision.
The Lancet report comes from the investigators in the UK (United Kingdom) Small Aneurysms Trial. They studied whether surveillance by ultrasonography (ultrasound) of small aneurysms before surgery to monitor their size would affect the long-term survival of patients who underwent early surgery.
Patients with small abdominal aneurysms were monitored. The aneurysms were from 4.0 to 5.5 cm in diameter. ( For aneurysms greater than 5.5 cm in diameter, surgeons favor an operation).
The patients were randomly assigned to one of two modes of management:
- Surgery in which the vessel was repaired with a graft; or
- Monitoring with ultrasonography until the size of the aneurysm was 5.5 cm or more, grew by at least 1.0 cm per year, or became tender, after which patients were offered surgery.
The conclusion of the UK report is that generally the use of "ultrasonographic surveillance for small abdominal aortic aneurysms is safe, and early surgery does not provide a long-term survival advantage".
The UK trial is important because "it has replaced many assumptions with facts, and the findings will transform the way patients and clinicians make decisions on the management of (sic) aortic aneurysms", note Drs. Rene Prêtre and Marko Turina from Zurich, Switzerland in a Commentary published in the same issue of The Lancet.
As the poet Robert Frost wrote (in another context, to be sure), "And wait to watch the water clear, I may." It would seem safe, in regard to small abdominal aortic aneurysms, to "wait to watch the water clear".
Please visit our Abdominal Aortic Aneurysm Center for more information.
Source: The Lancet, vol. 352, no. 9141, Nov. 21, 1998.