Author(s): Basílio, Francisco ; Coelho, Andreia ; Peixoto, João ; Fernandes, Luís ; Boal, Roberto ; Machado, Marta ; Carvalho, Patrícia ; Guimarães, Beatriz
Date: 2025
Origin: Portuguese Journal of Cardiac Thoracic and Vascular Surgery
Subject(s): Abdominal Aortic Aneurysms management; Long-term outcomes; Surgical intervention
Introduction: The risk of rupture for abdominal aortic aneurysms (AAAs) is primarily influenced by their diameter with the likelihood of rupture increasing exponentially as the aneurysm enlarges. Nowadays, giant AAAs are relatively rare in clinical practice due to earlier diagnosis and treatment. This study aimed to analyze the treatment and prognosis of giant aneurysms comparing with non-giant AAAs within our center´s prospective registry. Methods: We identified all AAAs treated at our center exceeding 9 cm in diameter from surgical records between January 1, 2013, and September 10, 2024. Demographic data, risk factors, anatomical characteristics, treatments, and outcomes were recorded. Furthermore, we analyzed and compared the anatomical features and outcomes of giant aneurysms with non-giant AAAs treated in our department (non-giant AAAs) from 2019 and 2023. Results: A total of 24 patients with giant AAAs were identified, with a mean age of 77 .46±9.03 years, and the majority were male (95.8%). Rupture was significantly more frequent in the giant AAAs cohort (54.2% vs. 9.6%, p<0.001). Additionally, Giant AAAs were significantly less likely to undergo endovascular aneurysm repair (EVAR) (33.33% vs. 75.53%, p < 0.001), but with a higher risk of reintervention due to complications at 30 days (18.18% vs. 1.18%, p < 0.001) and 1 year (18.18% vs. 3.53%, p < 0.001) in non-ruptured sub-group. Conclusion: Giant AAAs are predominantly ruptured at presentation and primarily managed with open surgical repair. When treated with EVAR, there was a higher risk of reintervention compared to non-giant AAAs.
