595 Dilemma in the Management of Saccular Aortic Aneurysms

Saccular aortic aneurysms (SAAs), characterized by spherical protrusions along a segment of the aortic circumference, lack well-defined management guidelines compared to fusiform aneurysms. Despite geometric indications of higher stress forces and rupture predisposition, real-world experiences differ. ESVS guidelines suggest earlier treatment for SAAs, but with a IIb C recommendation and limited evidence. This study aims to analyse SAAs between 2012-2022. All CT scan reports between 2012 to 2022 from a radiology database at a teaching were interrogated for the word “Saccular aneurysm”. The electronic patient records of these patients were then retrieved. Clinical and radiological findings were documented and analysed. Aneurysm growth rate was documented from the follow-up scans. Fifty-six patients (male: female ratio 3:1, mean age 78) were identified. Locations included ascending aorta (11%), aortic arch (8%), descending thoracic aorta (17%), and abdominal aorta (56%). Associated aneurysmal diseases were prevalent (77%), with thoracic aortic aneurysms (TAA) in 25% and abdominal aortic aneurysms (AAA) in 73%. SAA sizes ranged from 0.6 to 4.9 cm. During follow-up, 12 patients died (none from SAA rupture). Among 42 patients with follow-up scans, the average annual SAA growth rate was 1.26 cm, TAA was 0.61 cm, and AAA was 1.23 cm. Our small study did not find any faster growth rate of saccular aneurysm compared to the other co-existing fusiform aneurysms. Most incidental saccular aneuryms remained asymptomatic and relatively benign on follow up scans. Annual radiologic follow-up should be done for all but treatment should be offered after multidisciplinary discussion, on a case to case basis.