Endovascular Repair vs. Surveillance for Small Abdominal Aortic Aneurysms

In randomized trials involving patients with small (<5.5 cm) abdominal aortic aneurysms (AAAs), open repair was not superior to observation, in part because of morbidity and mortality associated with open repair. In a new U.S. multicenter randomized trial, investigators assigned 728 patients (mean age, 71) with 4- to 5-cm AAAs to endovascular repair — a procedure with lower operative mortality than open repair — or semiannual surveillance. Surveillance patients were offered endovascular repair when AAAs grew by more than 0.5 cm during any 6-month interval or when AAAs grew to >5.5 cm.

During mean follow-up of 20 months, the primary endpoint (AAA rupture or AAA-related death) occurred in only two patients in each group. Overall mortality also…