Long-Term Follow-Up of Men Invited to Participate in a Population-Based Abdominal Aortic Aneurysm Screening Program

Abstract

<jats:p> A screening program for abdominal aortic aneurysm (AAA), inviting 65-year-old men, was started in Stockholm in 2010 (2.3 million inhabitants). The aim was to present a long-term follow-up of men participating in screening, as well as AAA repair and ruptures among nonparticipants. Demographics were collected for men with screening detected with AAA 2010 to 2016 (n = 672) and a control group with normal aortas at screening (controls, n = 237). Medical charts and regional Swedvasc (Swedish Vascular registry) data were analyzed for aortic repair for men born 1945 to 1951. Ultrasound maximum aortic diameter (AD) as well as Aortic Size Index (ASI) was recorded. Participation was 78% and prevalence of AAA was 1.2% (n = 672). Aortic repair rates correlated with high ASI and AD. During the study period, 22% of the AAA patients were treated with the elective repair; 35 men in surveillance died (5.2%), non-AAA-related causes (82.9%) dominated, followed by unknown causes among 4 (11.4%), and 2 (5.7%) possibly AAA-related deaths. Abdominal aortic aneurysm rupture rate was higher among nonparticipants (0.096% vs 0.0036%, P &lt; .001). The low dropout rate confirms acceptability of follow-up after screening. The efficacy is shown by the much higher rupture rate among the nonparticipating men. </jats:p>

Debating the Usefulness of Abdominal Aortic Aneurysm Screening Programs: A Never-Ending Story

“…1 In contrast, patients not participating in the screening program had a >30-fold higher AAA rupture rate (0.096%; P < .001). 1 The usefulness of AAA screening programs is much debated. Some authors support that population-wide AAA screening programs are necessary and effective, [2][3][4] whereas others argue that these programs cause more harm than good.…”

“…11 Similarly, Hultgren et al reported that 82.9% of their AAA patients died from a non-AAA-related cause. 1 Thus, recognizing the presence of an AAA and treating it as a coronary heart disease equivalent may save more lives than just by dealing with AAAs.…”

“…Of the 662 men with a screening-detected abdominal aortic aneurysm (AAA) in the study by Hultgren et al, 1 149 (22.5%) eventually underwent elective treatment. More than two-thirds (69%) of the study participants with a screening-detected AAA measuring 45 to 49 mm at their first visit underwent elective repair within 3 years with a 30-day mortality of 0%.…”

“…More than two-thirds (69%) of the study participants with a screening-detected AAA measuring 45 to 49 mm at their first visit underwent elective repair within 3 years with a 30-day mortality of 0%. 1 Only 2 of these 662 patients (0.003%) presented with AAA rupture. 1 In contrast, patients not participating in the screening program had a >30-fold higher AAA rupture rate (0.096%; P < .001).…”

“…1 Only 2 of these 662 patients (0.003%) presented with AAA rupture. 1 In contrast, patients not participating in the screening program had a >30-fold higher AAA rupture rate (0.096%; P < .001). 1…”