In Reply.—Dr Ballard raises several questions regarding the prognosis of small abdominal aortic aneurysms (AAAs). First, our introductory comment that postoperative survival approaches that of the general population is supported by the reference cited in the article, but we agree that it is unlikely to equal population survival given the association of AAAs with other vascular disease. It was for this reason that we used the actual nonaneurysm mortality from series of patients with AAA described by Cronenwett et al1 to calculate the survival gained by surgery, and, therefore, we do not see how this argument casts doubt on our calculation.
Second, the fact that a minority of AAAs rupture while still small in no way contradicts our statement (again supported by the references cited) that one fourth to one half of all AAAs eventually rupture. Small AAAs usually grow larger before rupturing. Furthermore, one of the studies
LEDERLE FA, WALKER JM, REINKE DB. Selective Screening for Abdominal Aortic Aneurysms With Physical Examination and Ultrasound-Reply. Arch Intern Med. 1989;149(6):1466. doi:10.1001/archinte.1989.00390060167046