Study- If aneurysm unlikely to break, then don't fix it

Sunday, June 2, 2002

Two new studies on aortic aneurysms -- weak spots in the body's largest blood vessel that can burst and cause a person to drop dead -- suggest that many doctors can safely wait a little longer to operate than they used to.

Surgeons have long known that small aneurysms are unlikely to break, and they typically wait until the weak spot gets big enough to worry about. However, they disagreed over whether that should be 4, 5 or 6 centimeters, or anywhere from 1.6 to 2.4 inches.

The new studies set a higher threshold for what is "big enough," at least in men.

If the aorta balloons out less than 5.5 centimeters -- just under 2.2 inches -- it makes more sense to check it every six months rather than sew it back together immediately, surgeons with the U.S. Department of Veterans Affairs and the United Kingdom Small Aneurysm Trial concluded.

"A test like ultrasound typically costs $150 or $200. The operation is more on the order of $25,000 or more. You'd have to do a lot of surveillance before the cost was comparable," said Dr. Frank A. Lederle, director of the VA Medical Center in Minneapolis and lead author of the U.S. study.

Most aneurysms eventually will get big enough to need surgery. The question is whether the danger of death from the untreated aneurysm is greater than that from the operation itself.

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