SCREENING OF ABDOMINAL AORTIC ANEURYSM, CURRENT STATE OF THE ART
DOI:
https://doi.org/10.48750/acv.213Keywords:
Abdominal aortic aneurysm, Screening, Ultrasonography, Economic viability, SurveillanceAbstract
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.
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References
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a randomised controlled trial. Lancet. 2002;360(9345):1531-9.
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impact of screening on mortality from abdominal aortic aneurysm.
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of 65–73 year old men for abdominal aortic aneurysms in the
county of Viborg, Denmark. J Med Screen. 1996;3(1):43-6.
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the incidence of ruptured abdominal aortic aneurysm: 5-year results
of a randomized controlled study. Brit J Surg. 1995;82(8):1066-70.
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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
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of ultrasonographic scanning as screening method for abdominal
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17. Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, et
al. Management of abdominal aortic aneurysms clinical practice
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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
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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.
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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
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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.
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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
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Published
2019-05-15
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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 Nov. 23];14(4):315-26. Available from: https://acvjournal.com/index.php/acv/article/view/213
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