Small Abdominal Aortic Aneurysm Surveillance in the West of Ireland

Introduction: Surveillance of small abdominal aortic aneurysms (AAA) represents a significant workload for vascular surgery departments. The European Society for Vascular Surgery (ESVS) Guidelines advocate 3 yearly surveillance of AAA measuring 3-3.9cm, yearly for AAA measuring 4-4.9 and 6 monthly thereafter. Aim: The aim of this study was to evaluate current surveillance practices in our department. Methods: Small AAA patients were identified from a prospectively maintained single consultant database. The initial date of ultrasound assessment and subsequent ultrasound imaging, in addition to changes in aneurysm size were obtained from the vascular lab database (VascuBase). Data were also collated on surgical interventions, follow-up outpatient appointments and mortality rates. Results: A total of 85 small AAA patients were identified. Two thirds of patients (n=56, 66%) were male and 34% (n=29) were female. Patients were followed-up for a mean of 28.5 months (range 6-94 months), which included a mean of 4 ultrasound scans and 5 outpatient reviews. 18 patients (21%) proceed to aneurysm repair during the follow-up period. Of these, 17 patients (94%) were treated by endovascular aneurysm repair (EVAR) and 1 patient (6%) required an open repair. Overall mortality was 15% (n=13). Conclusion: Current surveillance practices with regard to ultrasound assessment and outpatient review exceed that which is recommended by the ESVS. Small AAA screening in GUH has now been modified to reflect guideline recommendations. Outpatient review will be performed only if patients reach threshold diameter for surgery or if the aneurysm increases in size rapidly.