RASTREIO DO ANEURISMA DA AORTA ABDOMINAL, ESTADO ATUAL DA ARTE
DOI:
https://doi.org/10.48750/acv.213Palavras-chave:
Aneurisma da aorta abdominal, Rastreio, Ultrassonografia, Viabilidade económica, VigilânciaResumo
O aneurisma da aorta abdominal (AAA) ocorre mais frequentemente em homens de idade avançada, raça caucasiana, com historial tabágico ou história familiar de AAA. Os AAA parecem ter indicação para rastreio populacional pela sua prevalência (4-8%) e mortalidade (80-90%); existência de período de latência até à rotura do aneurisma; uso de técnica eficaz, económica e segura para rastrear; e, tratamento com baixa taxa de mortalidade. O objetivo deste trabalho foi efetuar uma análise crítica dos resultados de programas de rastreio populacional de AAA e seu impacto na mortalidade. Na revisão bibliográfica analisou-se ainda se o decréscimo na prevalência na última década poderá ter implicações na viabilidade destes programas. Os estudos randomizados MASS, Chichester e Viborg demonstraram que o rastreio de AAA é viável, mesmo 13 a 15 anos após o início do programa. Dois dos estudos comprovaram o custo-eficácia de rastrear AAA. O estudo realizado na Austrália revelou-se não efetivo, provavelmente por um diagnóstico incidental elevado. A meta-análise destes estudos demonstrou que o rastreio populacional de AAA reduz a mortalidade relacionada com AAA em 4 por 1000 homens com mais de 65 anos e reduz a mortalidade por todas as causas a longo termo, em 5 por 1000. Um estudo de coorte com 61.982 participantes reportou uma redução no número de aneurismas rotos e na média do diâmetro aórtico ao longo de 20 anos. Estudos recentes sugerem que o rastreio de AAA é economicamente viável até uma prevalência de 0,5% nos homens e 1,1% nas mulheres. Modelos estatísticos demonstraram que o rastreio de AAA importa benefícios comparáveis com outros programas de rastreio. A implementação de programas populacionais de rastreio de AAA na população masculina com mais de 65 anos é viável e clinicamente relevante, contribuindo para uma redução na mortalidade associada aos AAA. O rastreio de mulheres, pelo menos com historial tabágico, parece ter legitimidade, mas é necessária maior evidência para determinar a sua viabilidade. Segundo dados dos programas “Aorta não avisa” e “Aorta é vida” a prevalência de AAA em Portugal é de cerca de 4%, o que parece justificar a implantação de programa de rastreio populacional no país.
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effect of abdominal aortic aneurysm screening on mortality in men:
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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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.
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12. Svensjö S, Björck M, Gurtelschmid M, Gidlund KD, Hellberg A,
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65-year-old Swedish men indicates a change in the epidemiology
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13. Mani K, Bjorck M, Wanhainen A. Changes in the management of
infrarenal abdominal aortic aneurysm disease in Sweden. Brit J
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14. Mani K, Lees T, Beiles B, Jensen LP, Venermo M, Simo G, et al. Treatment
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18. Powell JT, Brady AR, Brown LC, Forbes JF, Fowkes FGR, Greenhalgh
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1999;86(6):765-70.
21. Johnston KW. Ruptured abdominal aortic aneurysm: six-year
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2019-05-15
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Costa S, Machado R, Almeida R. RASTREIO DO ANEURISMA DA AORTA ABDOMINAL, ESTADO ATUAL DA ARTE. Angiol Cir Vasc [Internet]. 15 de Maio de 2019 [citado 24 de Novembro de 2024];14(4):315-26. Disponível em: https://acvjournal.com/index.php/acv/article/view/213
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