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Incidence of Ruptured Abdominal Aortic Aneurysms Has Decreased Significantly in the Last Decade: A 30-Year Population Based Study
Amanda J. Kravetz, MD, Manju Kalra, MBBS, Audra Duncan, MD, Thomas C. Bower, MD, Gustavo Oderich, MD, Mark Fleming, MD, William S. Harmsen, MS, Peter Gloviczki, MD.
Mayo Clinic, Rochester, MN, USA.
OBJECTIVES: Adoption of screening for and dissemination of endovascular repair of abdominal aortic aneurysms (AAA) has led to an increase in the number of elective aneurysm repairs. The aim of this study was to assess whether these measures have affected the incidence of rupture of abdominal aortic aneurysms (rAAA) in a defined population.
METHODS: A retrospective, population-based study was conducted with review of medical and death records of consecutive patients identified using ICD9/CPT codes for ruptured AAAs over a 30 year period from 1980 - 2010. The rupture rates were adjusted using the United States 2010 census data.
RESULTS: A total of 100 patients were identified; 79 males and 21 females. Median age at rupture was 75 years (range 55-101). Rupture was diagnosed at autopsy in 15 patients. Twenty-three patients had known AAAs; median time from diagnosis to rupture was 4.0 years (range 4 days - 12.6 years). Median aneurysm diameter at rupture was 6.9 cm (range 4-11). Repair was attempted in 73 patients (open - 71, endovascular - 2). There were 8 intra- and 11 post-operative deaths for a 30 day operative mortality of 26%. There were 5 further in-hospital deaths for an overall mortality of 51%. 67.1% (49/73) patients in whom repair was attempted left the hospital alive. Cumulative survival at 5, 10 and 15 years in the entire study cohort were 34%, 23% and 13% respectively; in survivors of rAAA repair were 55%, 37% and 22% respectively. No further aneurysm-related deaths were identified in follow-up. The age- and sex-adjusted incidence of rAAA was significantly lower in the 2000s (2.1 per 100,000 person years) compared to 8.0 in the 1990’s and 7.9 in the 1980’s, (p<0.001). The age-adjusted incidence for females in the 2000s, 1990s and 1980s (0.8, 1.6 and 3.2 respectively) was significantly lower than that for males (3.7, 16.0 and 13.8 respectively).
CONCLUSIONS: The incidence of ruptured abdominal aortic aneurysms decreased significantly during the last decade. This is likely a combination of easier identification by screening and widespread imaging as well as extension of elective repair to patients previously considered too high risk for repair. Further studies are needed to evaluate the incidence of AAA prevalence and elective repair in the same population over the same time period.
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