Ultrasonographic screening for the detection of abdominal aortic aneurysms.
BACKGROUND
The prevalence of abdominal aortic aneurysms (AAA) with a maximal diameter of 3 cm or more is age-dependent; among persons over age 65, it lies between 4% and 8% in men and between 0.5% and 1.5% in women. About 10% of all AAAs have a maximum diameter of 5 cm or more. The prognosis of ruptured AAA (rAAA) is dismal, with an overall mortality of at least 80%. Ultrasonography of the abdominal aorta is a safe and technically simple method of detecting AAAs.


METHODS
Evaluation of population-based, randomized studies of ultrasonographic screening for the detection of AAA, based on a selective review of the literature.


RESULTS
A meta-analysis of four randomized controlled studies showed that ultrasonographic screening was associated with a significant lowering of AAA-related mortality in men aged 65 to 80 after it had been performed for 3-5 years (risk reduction 44%, odds ratio [OR] 0.56, 95% confidence interval [CI] 0.44-0.72) and after it had been performed for 7-15 years (risk reduction 53%, OR 0.47, 95% CI 0.25-0.90). AAA screening was also associated with a significant lowering of the overall mortality after 7-15 years, but not in the first 5 years. Ultrasonographic screening led to a significant increase in the number of elective AAA operations performed and to a 50% reduction of the number of emergency operations for rAAA.


CONCLUSIONS
Ultrasonographic screening for AAA is a technically simple diagnostic test that is associated with a major reduction of AAA-related mortality. In view of the higher prevalence of AAA among the elderly, it is recommended that all men aged 65 or older and all men and women with a family history of AAA should be systematically screened. A national ultrasound screening program should be urgently implemented in Germany in order to bring about a major reduction in AAA-associated mortality.
Eckstein
Hans-Henning
HH
Klinik für Gefässchirurgie, Klinikum Rechts der Isar der Technischen Universität München. HHEckstein@web.de
Böckler
Dittmar
D
Flessenkämper
Ingo
I
Schmitz-Rixen
Thomas
T
Debus
Sebastian
S
Lang
Werner
W
D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D014463:Ultrasonography / Q000706:statistics & numerical data*