Screening and ultrasound surveillance of large abdominal aortic aneurysms do not improve suitability for endovascular repair.
OBJECTIVE
The effect of population screening for abdominal aortic aneurysm (AAA) disease on morbidity and mortality has been comprehensively studied and reported. However, the effect of early AAA detection on suitability for endovascular aneurysm repair (EVAR) remains unknown. Considering the importance of such an effect on future health economics, we sought to assess the possible effect of AAA ultrasound surveillance on suitability for EVAR.


METHODS
This was a prospective cohort study. From January 2002 to August 2003, consecutive AAA patients selected for open elective repair were placed into one of two groups according to mode of presentation. The first group included patients referred from a local well-established AAA ultrasound screening and surveillance program (ultrasound surveillance [AAA-S] group). The second group included patients referred from neighboring unscreened regions with incidentally diagnosed AAA (incidental [AAA-I] group). All patients underwent preoperative computed tomographic angiography. By using three-dimensional reconstruction software, computed tomographic images were assessed by two blinded observers for suitability for EVAR by using the criteria for a modular endovascular device.


RESULTS
Of 74 patients included in the study, 41 were in the AAA-S group, and 31 were in the AAA-I group. The median aneurysm diameter was 72.3 mm (range, 50.7-83.7 mm) for AAA-I and 65 mm (range, 50.7-79.2 mm) for AAA-S (P < .47). Suitability for EVAR was 41% in the AAA-S group and 45% in the AAA-I group (P < .47).


CONCLUSIONS
Early detection and surveillance of AAA does not seem to increase suitability for EVAR. Suitability for EVAR seems to be determined early on in an aneurysm's life. On the basis of current device technology, referral for intervention from an AAA surveillance program may need to be initiated at a size well below 5.5 cm if an increase in EVAR suitability is to be expected.
Department of Vascular Surgery, St Richards Hospital, Chichester, West Sussex, United Kingdom.
Andrew R
AR
Thompson
Alex
A
Rodway
Adam
A
Mitchell
Hany
H
Hafez
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery; D001027:Aortography / Q000379:methods; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D033162:Incidental Findings; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D012017:Referral and Consultation; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014656:Vascular Surgical Procedures