ABSTRACT
Due to the frequency of abdominal aneurysm deaths in the general population, and noninvasive access to the aorta by ultrasound, several large screening programs have been undertaken to diagnose and ultimately treat asymptomatic aneurysms. The detailed epidemiological information from the United Kingdom (UK) Small Aneurysm Trial published recently and the ongoing Aneurysm Detection and M an agement (AD AM ) Study were designed to answer the question whether a policy of early diagnosis and elective repair of small abdominal aneurysms is preferable to ultrasonographic surveillance.2,3 The UK trial demonstrated no benefit for early elec tive surgery over ultrasonographic surveillance of small aneurysms (< 5.5 cm). How ever, this may be attributed to a higher than expected operative mortality rate (5.8%) in this study. Had this trial achieved an elective surgical mortality rate of 2-3%, it is likely that early surgery would have shown significant benefit. We reported an even higher mortality rate (8.4%) when analyzing the results of all abdominal aneurysms electively repaired in the United States, which may reflect discrepancies between high-volume vascular centers and less specialized hospitals.1 The ADAM study is continuing and will further elucidate the correct management of patients with asymptomatic small aneurysms.
