Screening for abdominal aortic aneurysm

Paul Cosford, G. C. Leng

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: Abdominal aortic aneurysm (AAA) is found in 5% to 10% of men aged 65 to 79 years. The major complication is rupture which presents as a surgical emergency. The mortality after rupture is high, 80% for patients reaching hospital and 50% for those undergoing surgery for emergency repair. Currently elective surgical repair is recommended for aneurysms discovered to be larger than 5.5 cm to prevent rupture. There is interest in population screening to detect, monitor and repair abdominal aortic aneurysms before rupture. Objectives: To determine the effects of screening asymptomatic individuals for AAA on mortality, subsequent treatment, quality of life and cost effectiveness of screening. Search strategy: The Cochrane Peripheral Vascular Diseases Group searched their Trials Register (last searched 27 July 2007) and CENTRAL (last searched 2007, Issue 3). Selection criteria: Randomised controlled trials of population screening for AAA. Data collection and analysis: Two authors independently assessed trials and extracted data. Main results: Four studies involving 127,891 men and 9342 women were included in this review. Only one study included women. Results for men and women were analysed separately. Three to five years after screening there was no significant difference in all-cause mortality between screened and unscreened groups for men or women (men, odds ratio (OR) 0.95; 95% Confidence interval (CI) 0.85 to 1.07; for women OR 1.06; 95% CI 0.93 to 1.21). There was a significant decrease in mortality from AAA in men (OR 0.60; 95% CI 0.47 to 0.78), but not for women (OR 1.99; 95% CI 0.36 to 10.88). In this analysis mortality includes death from rupture and from emergency or elective surgery for aneurysm repair. There was also a decreased incidence of ruptured aneurysm in men (OR 0.45; 95% CI 0.21 to 0.99) but not in women (OR 1.49; 95% CI 0.25 to 8.94). There was a significant increase in surgery for AAA in men (OR 2.03; 95% CI 1.59 to 2.59). This was not reported in women. There were no data on life expectancy, complications of surgery or subjective quality of life. Authors' conclusions: There is evidence of a significant reduction in mortality from AAA in men aged 65 to 79 years who undergo ultrasound screening. There is insufficient evidence to demonstrate benefit in women. The cost effectiveness may be acceptable, but needs further expert analysis. These findings need careful consideration in judging whether a co-ordinated population-based screening programme should be introduced.

Translated title of the contributionScreening for abdominal aortic aneurysm
Original languageSpanish
Pages (from-to)127-136
Number of pages10
JournalAnales de Patologia Vascular
Volume3
Issue number2
Publication statusPublished - Apr 2009

Keywords

  • Aged
  • Aged, 80 and over
  • Aortic aneurysm, abdominal
  • Cost-benefit analysis
  • Female
  • Humans
  • Life expectancy
  • Male
  • Mass screening
  • Randomized controlled trials
  • Sex factors

Fingerprint

Dive into the research topics of 'Screening for abdominal aortic aneurysm'. Together they form a unique fingerprint.

Cite this