SCREENING OF ABDOMINAL AORTIC ANEURYSM, CURRENT STATE OF THE ART

Authors

  • Susana Costa Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - Universidade do Porto
  • Rui Machado Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - Universidade do Porto; Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário do Porto
  • Rui Almeida Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - Universidade do Porto; Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário do Porto

DOI:

https://doi.org/10.48750/acv.213

Keywords:

Abdominal aortic aneurysm, Screening, Ultrasonography, Economic viability, Surveillance

Abstract

Abdominal aortic aneurysm (AAA) occurs most often in older men, Caucasian, with history of smoking or family history of AAA. AAA seems to have indication for population screening for its prevalence (4-8%) and mortality (80-90%); existence of a latency period until aneurysm rupture; use of an efficient, economic and safe screening technique; and treatment with a low mortality rate. The objective of this work was to perform a critic analysis of the results of AAA population screening programs and their impact on mortality. It was also analyzed if the decrease in the prevalence in the last decade will have implications in the viability of these programs. The randomized trials MASS, Chichester and Viborg showed that the screening of AAA is feasible, even 13 to 15 years after the begging of the program. Two of the trials have proven that screening AAA is cost-effective. The trial performed in Australia revealed to be ineffective, probably due to a high incidental diagnosis. The meta-analysis of these studies has shown that population-based screening for AAA reduces the AAA-related mortality by 4 per 1000 men with 65 years or more and reduces all-cause mortality in the long-term, by 5 per 1000. A cohort study with 61,982 participants reported a reduction in the number of ruptured aneurysms and reduction of mean aortic diameter over 20 years. Recent studies suggest that screening of AAA is economically viable up to a prevalence of 0.5% in men and 1.1% in women. Statistical models have shown that screening of AAA has benefits comparable to other screening programs. The implementation of AAA population screening programs in the male population over 65 years-old is viable and clinically relevant, contributing to a reduction in mortality related to AAA. The screening in women, at least with history of smoking, appears to have legitimacy, but more evidence is needed to determine its viability. According to data of “Aorta não avisa” and “Aorta é Vida” programs the prevalence of AAA in Portugal is around 4%, which seems to justify the implementation of a population screening program in the country.

Downloads

Download data is not yet available.

References

1. Steinberg I. Arteriosclerotic abdominal aortic aneurysms - Report of 200 consecutive cases diagnosis by intravenous aortography. JAMA. 1966;195(12):149-53.
2. Wanhainen A, Thermudo R, Ahlstrom H, Lind L, Johausson L. Thoracic
and abdominal aortic dimension in 70-year-old men and women - A
population-based whole-body magnetic resonance imaging (MRI)
study. J Vasc Surg. 2008;47(3):504-12.
3. Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley
JC. Suggested standards for reporting on arterial aneurysms. J Vasc
Surg. 1991;13(3):452-8.
4. Gillum RF. Epidemiology of aortic-aneurysm in the United-States. J
Clin Epidemiol. 1995;48(11):1289-98.
5. Forsdahl SH, Singh K, Solberg S, Jacobsen BK. Risk factors for abdominal
aortic aneurysms: a 7-year prospective study: the Tromso
Study, 1994–2001. Circulation. 2009;119(16):2202-8.
6. Budd JS, Finch DR, Carter PG. A study of the mortality from ruptured
abdominal aortic aneurysms in a district community. Eur J Vasc Surg.
1989;3(4):351-4.
7. Ehlers L, Sorensen J, Jensen LG, Bech M, Kjolby M. Is population
screening for abdominal aortic aneurysm cost-effective? BMC
Cardiovasc Disord. 2008;8(32).
8. Ashton HA, Buxton MJ, Day NE, Kim LG, Marteau TM, Scott RAP, et
al. The Multicentre Aneurysm Screening Study (MASS) into the
effect of abdominal aortic aneurysm screening on mortality in men:
a randomised controlled trial. Lancet. 2002;360(9345):1531-9.
9. Norman PE, Jamrozik K, Lawrence-Brown MM, Le MTQ, Spencer CA,
Tuohy RJ, et al. Population based randomised controlled trial on
impact of screening on mortality from abdominal aortic aneurysm.
Brit Med J. 2004;329(7477):1259-62.
10. Lindholt JS, Henneberg EW, Fasting H, Juul S. Hospital based screening
of 65–73 year old men for abdominal aortic aneurysms in the
county of Viborg, Denmark. J Med Screen. 1996;3(1):43-6.
11. Scott RA, Wilson NM, Ashton HA, Kay DN. Influence of screening on
the incidence of ruptured abdominal aortic aneurysm: 5-year results
of a randomized controlled study. Brit J Surg. 1995;82(8):1066-70.
12. Svensjö S, Björck M, Gurtelschmid M, Gidlund KD, Hellberg A,
Wanhainen A. Low prevalence of abdominal aortic aneurysm among
65-year-old Swedish men indicates a change in the epidemiology
of the disease. Circulation. 2011;124(10):1118-23.
13. Mani K, Bjorck M, Wanhainen A. Changes in the management of
infrarenal abdominal aortic aneurysm disease in Sweden. Brit J
Surg. 2013;100(5):638-44.
14. Mani K, Lees T, Beiles B, Jensen LP, Venermo M, Simo G, et al. Treatment
of abdominal aortic aneurysm in nine countries 2005–2009: A
Vascunet Report. Eur J Vasc Endovasc. 2011;42(5):598-607.
15. Lederle FA, Walker JM, Reinke DB. Selective screening for abdominal
aortic aneurysms with physical examination and ultrasound. Arch
Intern Med. 1988;148(8):1753-6.
16. Lindholt JS, Vammen S, Juul S, Henneberg EW, Fasting H. The validity
of ultrasonographic scanning as screening method for abdominal
aortic aneurysm. Eur J Vasc Endovasc Surg. 1999;17(6):472-5.
17. Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, et
al. Management of abdominal aortic aneurysms clinical practice
guidelines of the european society for vascular surgery. Eur J Vasc
Endovasc. 2011;41:S1-S58.
18. Powell JT, Brady AR, Brown LC, Forbes JF, Fowkes FGR, Greenhalgh
RM, et al. Mortality results for randomised controlled trial of early
elective surgery or ultrasonographic surveillance for small abdominal
aortic aneurysms. Lancet. 1998;352(9141):1649-55.
19. McPhee JT, Hill JS, Eslami MH. The impact of gender on presentation,
therapy, and mortality of abdominal aortic aneurysm in the United
States, 2001–2004. J Vasc Surg. 2007;45(5):891-9.
20. Basnyat PS, Biffin AHB, Moseley LG, Hedges AR, Lewis MH. Mortality
from ruptured abdominal aortic aneurysm in Wales. Brit J Surg.
1999;86(6):765-70.
21. Johnston KW. Ruptured abdominal aortic aneurysm: six-year
follow-up results of a multicenter prospective study. Canadian
Society for Vascular Surgery Aneurysm Study Group. J Vasc Surg.
1994;19(5):888-900.
22. Wilson JMG, Jungner G, World Health Organization. Principles and Practice
of Screening for Disease. Geneva: Who; 1968;22(11):28-41. Disponível
em: http://apps.who.int/iris/bitstream/handle/10665/37650/
WHO_PHP_34.pdf?sequence=17&isAllowed=y
23. Ellis M, Powell JT, Greenhalgh RM. Limitations of ultrasonography
in surveillance of small abdominal aortic aneurysms. Br J Surg.
1991;78(5):614-6.
24. Lindholt JS, Sogaard R. Population screening and intervention for
vascular disease in Danish men (VIVA): a randomised controlled trial.
Lancet. 2017;390(10109):2256-65.
25. Vardulaki KA, Walker NM, Couto E, Day NE, Thompson SG, Ashton
HA, et al. Late results concerning feasibility and compliance from a
randomized trial of ultrasonographic screening for abdominal aortic
aneurysm. Brit J Surg. 2002;89(7):861-4.
26. Ashton HA, Gao L, Kim LG, Druce PS, Thompson SG, Scott RAP.
Fifteen-year follow-up of a randomized clinical trial of ultrasonographic
screening for abdominal aortic aneurysms. Brit J Surg.
2007;94(11):696-701.
27. Kim LG, Scott RAP, Ashton HA, Thompson SG. A sustained mortality
benefit from screening for abdominal aortic aneurysm. Ann Intern
Med. 2007;146(10):699-706.
28. Thompson SG, Ashton HA, Gao L, Scott RAP. Screening men for abdominal
aortic aneurysm: 10 year mortality and cost effectiveness
results from the randomised Multicentre Aneurysm Screening
Study. BMJ. 2009;338:b2307.
29. Thompson SG, Ashton HA, Gao L, Buxton MJ, Scott RA. Final follow-up of
the Multicentre Aneurysm Screening Study (MASS) randomized trial of
abdominal aortic aneurysm screening. Br J Surg. 2012;99(12):1649-56.
30. Lindholt JS, Juul S, Fasting H, Henneberg EW. Screening for abdominal
aortic aneurysms: single centre randomised controlled trial.
Brit Med J. 2005;330(7494):750-5.
31. Lindholt JS, Juul S, Fasting H, Henneberg EW. Preliminary ten year
results from a randomised single centre mass screening trial for
abdominal aortic aneurysm. Eur J Vasc Endovasc. 2006;32(6):608-14.
32. Lindholt JS, Sorensen J, Sogaard R, Henneberg EW. Long-term benefit and
cost-effectiveness analysis of screening for abdominal aortic aneurysms
from a randomized controlled trial. Br J Surg. 2010;97(6):826-34.
33. Lindholt JS, Juul S, Henneberg EW. High-risk and low-risk screening
for abdominal aortic aneurysm both reduce aneurysm-related
mortality. A stratified analysis from a single-centre randomised
screening trial. Eur J Vasc Endovasc. 2007;34(1):53-8.
34. McCaul KA, Lawrence-Brown M, Dickinson JA, Norman PE. Long-
-term outcomes of the Western Australian Trial of screening for
abdominal aortic aneurysms secondary analysis of a randomized
clinical trial. JAMA Intern Med. 2016;176(12):1761-7.
35. Grondal N, Sogaard R, Henneberg EW, Lindholt JS. The Viborg
vascular (VIVA) screening trial of 65–74 year old men in the central
region of Denmark: study protocol. Trials. 2010;11(67):1-6.
36. Grondal N, Sogaard R, Lindholt JS. Baseline prevalence of abdominal
aortic aneurysm, peripheral arterial disease and hypertension in
men aged 65–74 years from a population screening study (VIVA
trial). Brit J Surg. 2015;102(8):902-6.
37. Cosford PA, Leng GC. Screening for abdominal aortic aneurysm
(Review). Cochrane Database Syst Rev. 2007(2):1-18.
38. Lindholt JS, Fasting U. Screening for abdominal aortic aneurysm
among patients referred to vascular laboratory. Indeed feasible -
But acceptable? Eur J Vasc Endovasc. 2008;35(6):675-6.
39. Takagi H, Tanabashi T, Kawai N, Kato T, Umemoto T. Abdominal aortic
aneurysm screening reduces mortality: Meta-analyses of randomized,
controlled trials. Eur J Vasc Endovasc. 2007;33(1):132-3.
40. Takagi H, Goto S, Matsui M, Manabe H, Umemoto T. A further meta-
-analysis of population-based screening for abdominal aortic
aneurysm. J Vasc Surg. 2010;52(4):1103-8.
41. Takagi H, Ando T, Umemoto T. Abdominal aortic aneurysm screening
reduces all-cause mortality: make screening great again. Angiology.
2018;69(3):205-11.
42. Lindholt JS, Norman P. Screening for abdominal aortic aneurysm
reduces overall mortality in men. A meta-analysis of the mid- and
long-term effects of screening for abdominal aortic aneurysms. Eur
J Vasc Endovasc. 2008;36(2):167-71.
43. Gotzsche PC, Nielsen M. Screening for breast cancer with mammography.
Cochrane Database Syst Rev. 2006(4):1-61.
44. Hewitson P, Glasziou P, Watson E, Towler B, Irwig L. Cochrane systematic
review of colorectal cancer screening using the fecal occult blood
test (hemoccult): an update. Am J Gastroenterol. 2008;103(6):1541-9.
45. Schroder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen
V, et al. Screening and prostate-cancer mortality in a randomized
European study. N Engl J Med. 2009;360(13):1320-8.
46. Gotzsche PC. Relation between breast cancer mortality and screening
effectiveness: systematic review of the mammography trials.
Dan Med Bull. 2011;58(3):A4246.
47. Darwood R, Earnshaw JJ, Turton G, Shaw E, Whyman M, Poskitt K, et al.
Twenty-year review of abdominal aortic aneurysm screening in men in the
county of Gloucestershire, United Kingdom. J Vasc Surg. 2012;56(1):8-14.
48. Duncan J, Harrild K, Iversen L, Lee A, Godden D. Long-term outcomes
in men screened for Abdominal Aortic Aneurysm: a prospective
cohort study. Brit J Surg. 2012;344(e2958):1-9.
49. Waterhouse DF, Cahill RA. Simple adaptation of current abdominal
aortic aneurysm screening programs may address all-cause cardiovascular
mortality: Prospective observational cohort study. Am
Heart J. 2008;155(5):938-45.
50. LeFevre ML. Screening for Abdominal Aortic Aneurysm: U.S. Preventive
Services Task Force Recommendation Statement. Ann Intern
Med. 2014;161(4):281-91.
51. Lim LS, Haq N, Mahmood S, Hoeksema L, Comm APP. Atherosclerotic
cardiovascular disease screening in adults american college
of preventive medicine position statement on preventive practice.
Am J Prev Med. 2011;40(3):e1-10.
52. Surgery TCSfV. Canadian Society Surgery (CSVS) Statement on
AAA Screening 2008. Disponível em: https://canadianvascular.ca/
Resources/Documents/AAA_statement08.pdf.
53. Singh H, Bell N, Dickinson JA, Lewin G, Tonelli M, Thombs B, et al.
Recommendations on screening for abdominal aortic aneurysm in
primary care. Can Med Assoc J. 2017;189(36):E1137-E45.
54. Conway AM, Malkawi AH, Hinchliffe RJ, Holt PJ, Murray S, Thompson
MM, et al. First-year results of a national abdominal aortic aneurysm
screening programme in a single centre. Brit J Surg. 2012;99(1):73-7.
55. Davis M, Harris M, Earnshaw JJ. Implementation of the National
Health Service Abdominal Aortic Aneurysm Screening Program in
England. J Vasc Surg. 2013;57(5):1440-5.
56. Jacomelli J, Summers L, Stevenson A, Lees T, Earnshaw JJ. Impact of
the first 5 years of a national abdominal aortic aneurysm screening
programme. Br J Surg. 2016;103(9):1125-31.
57. Benson RA, Poole R, Murray S, Moxey P, Loftus IM. Screening results from
a large United Kingdom abdominal aortic aneurysm screening center in
the context of optimizing United Kingdom National Abdominal Aortic
Aneurysm Screening Programme protocols. J Vasc Surg. 2016;63(2):301-4.
58. Wanhainen A, Hultgren R, Linne A, Holst J, Gottsater A, Langenskiold
M, et al. Outcome of the Swedish Nationwide Abdominal Aortic
Aneurysm Screening Program. Circulation. 2016;134(16):1141-8.
59. Olchanski N, Winn A, Cohen JT, Neumann PJ. Abdominal aortic
aneurysm screening: how many life years lost from underuse of the
medicare screening benefit? J Gen Intern Med. 2014;29(8):1155-61.
60. Shreibati JB, Baker LC, Hlatky MA, Mell MW. Impact of the Screening
Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act
on abdominal ultrasonography use among Medicare beneficiaries.
Arch Intern Med. 2012;172(19):1456-62.
61. Fernandes e Fernandes J. Rede de Referenciação Hospitalar Angiologia
e Cirurgia Vascular. 2017.
62. Sousa P, Fernandes e Fernandes J. A cirurgia vascular em Portugal
de 2005 a 2025: conhecer para melhorar. Faculdade de Medicina da
Universidade de Lisboa, 2016.
63. Castro-Ferreira R, Mendes P, Couto P, Barreira R, Peixoto F, Aguiar
M, et al. Rastreio populacional de aneurisma da aorta abdominal
em Portugal - o imperativo da sua realização. Angiologia e Cirurgia
Vascular. 2016;12(4):267-70.
64. Porto NU. FMUP desenvolve rastreio inédito de Aneurisma da Aorta
Abdominal, 2016. Disponível em: https://noticias.up.pt/fmup-desenvolve-
rastreio-inedito-de-aneurisma-da-aorta-abdominal/.
65. Machado R, Teixeira G, Oliveira P, Loureiro L, Pereira C, Almeida R. Endovascular
Abdominal Aneurysm Repair in Women: What are the Differences
Between the Genders? Braz J Cardiova Surg. 2016;31(3):232-8.
66. Scott RAP, Bridgewater SG, Ashton HA. Randomized clinical trial
of screening for abdominal aortic aneurysm in women. Brit J Surg.
2002;89(3):283-5.
67. Derubertis BG, Trocciola SM, Ryer EJ, Pieracci FM, McKinsey JF,
Faries PL, et al. Abdominal aortic aneurysm in women: prevalence,
risk factors, and implications for screening. J Vasc Surg.
2007;46(4):630-5.
68. Svensjö S, Björck M, Wanhainen A. Current prevalence of abdominal
aortic aneurysm in 70-year-old women. Br J Surg. 2013;100(3):367-72.
69. Ulug P, Powell JT, Sweeting MJ, Bown MJ, Thompson SG, Group SC.
Meta-analysis of the current prevalence of screen-detected abdominal
aortic aneurysm in women. Br J Surg. 2016;103(9):1097-104.
70. Wanhainen A, Lundkvist J, Bergqvist D, Bjorck M. Cost-effectiveness
of screening women for abdominal aortic aneurysm. J Vasc Surg.
2006;43(5):908-14.
71. Thompson SG, Brown LC, Sweeting MJ, Bown MJ, Kim LG, Glover
MJ, et al. Systematic review and meta-analysis of the growth and
rupture rates of small abdominal aortic aneurysms: implications for
surveillance intervals and their cost-effectiveness. Health Technol
Assess. 2013;17(41):1-118.
72. Hafez H, Druce PS, Ashton HA. Abdominal aortic aneurysm development
in men following a "normal" aortic ultrasound scan. Eur J Vasc
Endovasc Surg. 2008;36(5):553-8.
73. Wild JB, Stather PW, Biancari F, Choke EC, Earnshaw JJ, Grant SW, et
al. A multicentre observational study of the outcomes of screening
detected sub-aneurysmal aortic dilatation. Eur J Vasc Endovasc
Surg. 2013;45(2):128-34.
74. Svensjö S, Björck M, Wanhainen A. Editor's choice: five-year
outcomes in men screened for abdominal aortic aneurysm at 65
years of age: a population-based cohort study. Eur J Vasc Endovasc
Surg. 2014;47(1):37-44.
75. Sogaard R, Laustsen J, Lindholt JS. Cost effectiveness of abdominal
aortic aneurysm screening and rescreening in men in a modern
context: evaluation of a hypothetical cohort using a decision analytical
model. BMJ. 2012;345(e4276):1-13.
76. Thapar A, Cheal D, Hopkins T, Ward S, Shalhoub J, Yusuf SW. Internal
or external wall diameter for abdominal aortic aneurysm screening?
Ann R Coll Surg Engl. 2010;92(6):503-5.
77. Chiu KW, Ling L, Tripathi V, Ahmed M, Shrivastava V. Ultrasound
measurement for abdominal aortic aneurysm screening: a direct
comparison of the three leading methods. Eur J Vasc Endovasc Surg.
2014;47(4):367-73.
78. Meecham L, Evans R, Buxton P, Allingham K, Hughes M, Rajagopalan
S, et al. Abdominal aortic aneurysm diameters: A study on the discrepancy
between inner to inner and outer to outer measurements. Eur
J Vasc Endovasc Surg. 2015;49(1):28-32.
79. Borgbjerg J, Bogsted M, Lindholt JS, Behr-Rasmussen C, Horlyck A,
Frokjaer JB. Superior reproducibility of the leading to leading edge and
inner to inner edge methods in the ultrasound assessment of maximum
abdominal aortic diameter. Eur J Vasc Endovasc Surg. 2018;55(2):206-13.
80. Smith RW, Evans T, Wolstenhulme S. Reliability of aortic aneurysm
screening measurements. Ultrasound. 2014;22(2):80-90.
81. Rawlins MD, Culyer AJ. National Institute for Clinical Excellence and
its value judgments. Brit Med J. 2004;329(7459):224-7.
82. Glover MJ, Kim LG, Sweeting MJ, Thompson SG, Buxton MJ. Cost-
-effectiveness of the National Health Service Abdominal
Aortic Aneurysm Screening Programme in England. Br J Surg.
2014;101(8):976-82.
83. Giardina S, Pane B, Spinella G, Cafueri G, Corbo M, Brasseur P, et al.
An economic evaluation of an abdominal aortic aneurysm screening
program in Italy. J Vasc Surg. 2011;54(4):938-46.
84. Spronk S, van Kempen BJ, Boll AP, Jorgensen JJ, Hunink MG, Kristiansen
IS. Cost-effectiveness of screening for abdominal
aortic aneurysm in the Netherlands and Norway. Br J Surg.
2011;98(11):1546-55.
85. Ehlers L, Overvad K, Sorensen J, Christensen S, Bech M, Kjolby M.
Analysis of cost effectiveness of screening Danish men aged 65 for
abdominal aortic aneurysm. BMJ. 2009;338:1-7.
86. Svensjö S, Mani K, Björck M, Lundkvist J, Wanhainen A. Screening for
abdominal aortic aneurysm in 65-year-old men remains cost-effective
with contemporary epidemiology and management. Eur J Vasc
Endovasc. 2014;47(4):357-65.
87. Zarrouk M, Lundqvist A, Holst J, Troeng T, Gottsater A. Cost-effectiveness
of screening for abdominal aortic aneurysm in combination
with medical intervention in patients with small aneurysms. Eur J
Vasc Endovasc Surg. 2016;51(6):766-73.
88. Lesjak M, Boreland F, Lyle D, Sidford J, Flecknoe-Brown S, Fletcher
J. Screening for abdominal aortic aneurysm: does it affect men's
quality of life? Aust J Prim Health. 2012;18(4):284-8.
89. Ericsson A, Holst J, Gottsater A, Zarrouk M, Kumlien C. Psychosocial
consequences in men taking part in a national screening program
for abdominal aortic aneurysm. J Vasc Nurs. 2017;35(4):211-20.
90. Bertero C, Carlsson P, Lundgren F. Screening for abdominal aortic
aneurysm, a one-year follow up: an interview study. J Vasc Nurs.
2010;28(3):97-101.
91. Pettersson M, Hansson A, Brodersen J, Kumlien C. Experiences of
the screening process and the diagnosis abdominal aortic aneurysm
among 65-year-old men from invitation to a 1-year surveillance. J
Vasc Nurs. 2017;35(2):70-7.

Published

2019-05-15

How to Cite

1.
Costa S, Machado R, Almeida R. SCREENING OF ABDOMINAL AORTIC ANEURYSM, CURRENT STATE OF THE ART. Angiol Cir Vasc [Internet]. 2019 May 15 [cited 2024 Mar. 29];14(4):315-26. Available from: https://acvjournal.com/index.php/acv/article/view/213

Issue

Section

Review Article