New data suggest patients at AAA repair thresholds can be safely deferred

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Mark A. Eid

Data from the PROVE-AAA cluster-randomized trial (Preferences for open versus endovascular repair of abdominal aortic aneurysm) of a novel decision aid to assist veterans decide between their options demonstrated that surgeons can safely defer AAA repair in patients with a 5cm-plus aneurysm diameter “for a moderate time.”

Mark A. Eid, MD, a general surgery resident at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and colleagues from the PROVE-AAA research team looked at 235 patients enrolled across 23 VA medical centers—109 at 11 control sites and 126 at 12 intervention sites who were either provided with their usual preoperative care or a decision aid before meeting with their surgeon. The full cohort were then given a series of surveys to assess their preferences, ultimately making the decision to either undergo surgery or active surveillance.

“Among the study participants who deferred surgery, 23 were in the decision aid arm, while 17 were in the control arm who received their usual care,” Eid said as he presented results from the study at the 2022 Vascular Annual Meeting (VAM) in Boston (June 15–18).

Within the decision aid group, some 13% of veterans chose to defer their care—compared to 15% among those who received their usual care. “The vast majority of those who deferred were still awaiting surgery, primarily due to OR shutdowns at the beginning of the COVID-19 pandemic,” Eid revealed, also showing that more veterans in the decision aid group chose to refuse surgery compared to their counterparts receiving usual care.

“At the end of our surveillance period in the summer of 2020, no veterans had suffered aneurysm death or rupture.”

Furthermore, the PROVE-AAA study showed approximately 20% of veterans with a AAA meeting Society for Vascular Surgery (SVS) criteria for repair had their repair deferred, and that this contingent were similarly satisfied to those who underwent surgery, Eid concluded. “At least in the short term, our data suggests that even patients at or slightly above the repair thresholds can safely consider their choice about proceeding with their aneurysm.”

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