Balancing Watching vs Waiting During Imaging Surveillance of Small Abdominal Aortic Aneurysms

The primary outcomes of the Non-Invasive Treatment of Abdominal Aortic Aneurysm Clinical Trial (N-TA³-CT) trial¹ did not suggest a benefit from oral doxycycline over placebo on abdominal aortic aneurysm (AAA) growth. Clinicians treating patients with small, asymptomatic AAA therefore remain in the familiar (and somewhat anxious) situation of needing long-term imaging surveillance without evidence-based treatments demonstrated to prevent growth. A secondary analysis of the N-TA³-CT data set by Olson et al² in this issue of JAMA Surgery takes advantage of a unique cohort of more than 250 patients with small aneurysms who were studied with serial computed tomography imaging. None of the patients in the current study² with a baseline maximum transverse aneurysm diameter less than 4.25 cm exceeded diameter-based repair thresholds at 2 years, suggesting that patients in this category may not require imaging surveillance on an annual basis. Less frequent surveillance would potentially benefit patients through lower risk (including less contrast and radiation exposure) and decreased costs.