Risk of rupture and all-cause mortality of abdominal aortic ectasia: a systematic review and meta-analysis

To clarify the natural fate of abdominal aortic ectasia (AAE) measuring 25-29 mm in maximal diameter and to determine the optimal follow-up based on the growth, risk of rupture and overall mortality of AAE.A systematic review and meta-analysis of AAE in accordance with PRISMA guidelines.We searched MEDLINE, Web of Science Core Collection, and Google Scholar with help from a health sciences librarian through August 11, 2021.Those studies with longitudinal outcomes of AAE (prevalence, annual growth rate, aneurysmal enlargement, rupture, aneurysm-related death and all-cause mortality) were included. Meta-analyses were conducted with a random-effects model RESULTS: Twelve studies describing a total of 8369 patients were eligible. Prevalence at population-based settings was 3.2% (95% confidence interval [CI] 2.4%-4.0%), whose annual growth rate was 0.82 mm/year (95% CI 0.20-1.45 mm/year). Estimated risks of aortic diameters exceeding 30 mm and 55mm in 5 years were 45.0% (95% CI 28.5%-61.5%) and 0.3% (95% CI 0%-0.6%) respectively, while those beyond 5 years were 70.2% (95% CI 46.9%-93.6%) and 5.2% (95% CI 2.2%-8.2%). Rates of rupture and aneurysm-related death were minimal until 5 years (0.1% and 0.1%) and beyond (0.4% and 0.2%). Overall mortality was 7.5% (95% CI 3.9%-11.0%) and 17.3% (95% CI 9.5%-25.1%) until and beyond 5 years. Overall mortality from 3 studies showed no statistical difference between AAE and aneurysms (HR 0.62, 95% CI 0.32-1.21, p = .16). Cancer (35.0%) and cardiovascular diseases (31.9%) were major causes of death.AAE carries minimal risk of aneurysm-related lethal events during the first 5 years, but similar risk of overall mortality as abdominal aortic aneurysm. Cancer and cardiovascular diseases are leading causes of mortality in patients with AAE.