Correspondence

Repair of Small Abdominal Aortic Aneurysms

N Engl J Med 2006; 354:1537-1538April 6, 2006

Article

To the Editor:

The recently issued guidelines of the American College of Cardiology and the American Heart Association (ACC–AHA) for the care of patients with peripheral arterial disease include the following recommendation regarding abdominal aortic aneurysms: “Repair can be beneficial in patients with infrarenal or juxtarenal [abdominal aortic aneurysms] 5.0 to 5.4 cm in diameter.”1 The document then describes two randomized trials, conducted by us and published together in the Journal, 2,3 that compared repair with surveillance for abdominal aortic aneurysms 4.0 to 5.4 cm in diameter. Both trials reported no benefit from repair of abdominal aortic aneurysms less than 5.5 cm in diameter or in any subgroup of patients defined by aneurysm diameter at entry, a finding that directly refutes the ACC–AHA recommendation, for which no alternative justification is presented. The issuance of guidelines is an opportunity to disseminate and implement information that has been obtained at great cost and effort. It is unfortunate when such recommendations misrepresent that information.

Frank A. Lederle, M.D.
Veterans Affairs Medical Center, Minneapolis, MN 55417
frank.lederle@va.gov

Janet T. Powell, M.D., Ph.D.
Roger M. Greenhalgh, M.D.
Imperial College London, London W68RP, United Kingdom

3 References

1. 1

   Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary. J Am Coll Cardiol 2006;47:1239-1312
   CrossRef | Web of Science | Medline

2. 2

   Lederle FA, Wilson SE, Johnson GR, et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 2002;346:1437-1444
   Full Text | Web of Science | Medline

3. 3

   The United Kingdom Small Aneurysm Trial Participants. Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 2002;346:1445-1452
   Full Text | Web of Science | Medline

Citing Articles (2)

Citing Articles

1. 1

   T. Gregory Walker, Sanjeeva P. Kalva, Kalpana Yeddula, Stephan Wicky, Sanjoy Kundu, Peter Drescher, B. Janne d'Othee, Steven C. Rose, John F. Cardella. (2010) Clinical Practice Guidelines for Endovascular Abdominal Aortic Aneurysm Repair: Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association. Journal of Vascular and Interventional Radiology 21:11, 1632-1655
   CrossRef

2. 2

   Joseph J. Ricotta, Rafael D. Malgor, Gustavo S. Oderich. (2009) Endovascular Abdominal Aortic Aneurysm Repair: Part I. Annals of Vascular Surgery 23:6, 799-812
   CrossRef