Repair of Small Abdominal Aortic Aneurysms

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Abstract
The recently issued guidelines of the American College of Cardiology and the American Heart Association (ACC–AHA) for the care of patients with peripheral arterial disease include the following recommendation regarding abdominal aortic aneurysms: “Repair can be beneficial in patients with infrarenal or juxtarenal [abdominal aortic aneurysms] 5.0 to 5.4 cm in diameter.”1 The document then describes two randomized trials, conducted by us and published together in the Journal, 2,3 that compared repair with surveillance for abdominal aortic aneurysms 4.0 to 5.4 cm in diameter. Both trials reported no benefit from repair of abdominal aortic aneurysms less than 5.5 cm in diameter or in any subgroup of patients defined by aneurysm diameter at entry, a finding that directly refutes the ACC–AHA recommendation, for which no alternative justification is presented. The issuance of guidelines is an opportunity to disseminate and implement information that has been obtained at great cost and effort. It is unfortunate when such recommendations misrepresent that information.