Radiographic monitoring of incidental abdominal aortic aneurysms: a retrospective population-based cohort

Background — An abdominal aortic aneurysm (AAA) that is identified when the abdomen is imaged for some other reason is known as an incidental AAA. No population-based studies have assessed the management of incidental AAAs. The objective of this study was to measure the completeness of radiographic monitoring of incidental AAAs by means of a population-based analysis.

Method — Linked a cohort of patients with incidental AAA (defined as a previously unidentified aortic enlargement exceeding 30 mm in diameter found in an imaging study performed for another reason) to various population-based databases. Followed the patients to elective repair or rupture of the aneurysm, death or March 31, 2009. Used evidence-based monitoring guidelines to calculate the proportion of observation time during which each incidental AAA was incompletely monitored, and used negative binomial regression to determine the association of patient-related factors with this outcome.

Results — For the period between January 1996 and September 2008, 191 patients were identified with incidental AAA (mean diameter 37.6 mm, 95% confidence interval [CI] 36.6–38.6 mm; median follow-up 4.4 [range 0.6–12.7] years). Fifty-six of these patients (29.3%) had no radiographic monitoring of the aneurysm. Overall, patients spent one-fifth of their time with incomplete monitoring of the AAA (median 19.4%, interquartile range 0.3%–44.0%). Factors independently associated with incomplete monitoring included older age (relative rate [change in proportion of time with incomplete monitoring] [RR] 1.27, 95% CI 1.10–1.47, per decade), larger size (RR 1.65, 95% CI 1.38–2.01, per 10 mm increase) and detection of the aneurysm while the patient was in hospital or the emergency department (RR 1.34, 95% CI 1.00–1.79). Comorbidities were not associated with monitoring.

Interpretation — Radiographic monitoring of incidental AAAs was incomplete, and almost one-third of patients underwent no monitoring at all. Incomplete monitoring did not appear to be related to patients' comorbidity.