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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms
New England Journal of Medicine, Volume 346, No. 19, Year 2002
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Description
Background: Two clinical trials, one British and one American, have shown that early, prophylactic elective surgery does not improve five-year survival among patients with small abdominal aortic aneurysms. We report long-term outcomes in the United Kingdom Small Aneurysm Trial. Methods: We randomly assigned 1090 patients, 60 to 76 years of age, with small abdominal aortic aneurysms (diameter, 4.0 to 5.5 cm) to one of two groups: 563 were assigned to undergo early elective surgery, and 527 were assigned to undergo surveillance by ultrasonography. Patients were followed in the trial until June 1998 and thereafter until August 2001; the mean duration of follow-up was 8 years (range, 6 to 10). Results: The mean duration of survival was 6.5 years among patients in the surveillance group, as compared with 6.7 years among patients in the early-surgery group (P=0.29). The adjusted hazard ratio for death from any cause in the early-surgery group as compared with the surveillance group was 0.83 (95 percent confidence interval, 0.69 to 1.00; P=0.05). The 30-day operative mortality in the early-surgery group (5.5 percent) led to an early disadvantage in terms of survival. The survival curves crossed at three years, and at eight years, mortality in the early-surgery group was 7.2 percentage points lower than that in the surveillance group (P=0.03). There was no evidence that age, sex, or the initial size of the aneurysm modified the hazard ratio or that delayed surgery in the surveillance group increased 30-day postoperative mortality. Death was attributable to a ruptured aneurysm in 19 of the 411 men who died (5 percent) and in 12 of the 85 women who died (14 percent) (P=0.001). The rate of early cessation of smoking was higher in the early-surgery group than in the surveillance group. Conclusions: Among patients with a small abdominal aortic aneurysm, we found no long-term difference in mean survival between the early-surgery and surveillance groups, although after eight years, total mortality was lower in the early-surgery group. This difference may be attributed in part to beneficial changes in lifestyle adopted by members of the early-surgery group. Copyright © 2002 Massachusetts Medical Society.
Authors & Co-Authors
Brown, Louise Clare
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Fowkes, Francis Gerald R.
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Powell, Janet Tinka
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Thompson, Simon G.
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Shearman, Clifford P.
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Clarke, Robert Joseph
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Stewart, Grant D.
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Davidson, Alan I.G.
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Baker, Richard H.
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Forsythe, John L.R.
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Bell, Petterrf R.F.
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Coen, Lionello D.
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Michaels, Jonathan A.
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Beard, Jonathan D.
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Davies, Alun Huw
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Hamilton, George A.
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Statistics
Citations: 548
Authors: 16
Affiliations: 1
Identifiers
Doi:
10.1056/NEJMoa013527
ISSN:
00284793
Research Areas
Environmental
Health System And Policy
Study Design
Cohort Study
Participants Gender
Male
Female