Small Abdominal Aortic Aneurysm Surveillance In The West Of Ireland

Objective: Surveillance of small abdominal aortic aneurysms (AAAs) represents a significant workload for vascular surgery departments. The European Society for Vascular Surgery (ESVS) Guidelines advocate three yearly surveillance of AAA measuring 3 – 3.9 cm, yearly for AAA measuring 4 – 4.9 cm, and six monthly thereafter. The aim of this study was to evaluate current surveillance practices in the Vascular Surgery Department at Galway University Hospital (GUH). Methods: Patients with small AAAs were identified from a prospectively maintained single consultant database. The initial date of ultrasound assessment, subsequent ultrasound imaging, and changes in aneurysm size were obtained from the vascular lab database (VascuBase). Results: A total of 74 patients were diagnosed with AAA between January 2009 and December 2018. Two thirds of patients (n = 49, 66%) were male and 34% (n = 25) were female. Patients were followed up for a mean of 28.5 months (range 6 – 94 months), which included a mean of 4.85 ultrasound scans and 4.6 outpatient reviews. Five patients had initial AAA diameters > 5 cm. Of the 40 patients with AAA diameter 4 – 4.9 cm, 29 (72%) were seen before the recommended one year follow up. Twenty-four patients had a AAA diameter 3 – 3.9 cm, of which 16 (66%) were seen in the first year. Five patients had an initial AAA size < 3 cm and remained in screening. Conclusion: Current surveillance practices about ultrasound assessment and outpatient review exceed that which is recommended by the ESVS. Small AAA screening in GUH has now been modified to reflect guideline recommendations. Outpatient review will be performed only if patients reach threshold diameter for surgery or if the aneurysm increases in size rapidly.