Predictors of Abdominal Aortic Aneurysm (AAA) Growth and AAA Rupture Risk Besides AAA Size: Fact or Fiction?

Flondell-Site et al in this issue of Angiology report that besides abdominal aortic aneurysm (AAA) diameter (P 1⁄4 .0019), endothelin-1 (ET-1) levels (P 1⁄4 .0230) were significant predictors of AAA growth in 178 patients with AAA followed conservatively (mean: 2.9 + 1.6 years). In univariate analysis, ET-1 levels also predicted death or need for AAA surgery. These results suggest an alternative/additional predictor of AAA growth and rupture risk besides AAA diameter. Currently, the main criterion for AAA repair is an AAA diameter 5.5 cm. The 5.5-cm diameter threshold is the size when the AAA rupture rate balances the mortality rates of elective AAA repair (3%). However, some AAAs rupture when they are smaller and many are discovered after they have exceeded this critical diameter but have not ruptured. It therefore seems that size alone is not sufficient to assess AAA rupture risk. The discovery of alternative predictors of AAA growth and rupture risk holds implications for a more appropriate (earlier/later) surgical management of AAAs. This Editorial discusses potential predictors of AAA growth and rupture risk besides AAA diameter and ET-1.