Primary Care Screening for Abdominal Aortic Aneurysm

Abstract

IMPORTANCE Ruptured abdominal aortic aneurysms (AAAs) have mortality estimated at 81%. OBJECTIVE To systematically review the evidence on benefits and harms of AAA screening and small aneurysm treatment to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed (publisher supplied only), Database of Abstracts of Reviews of Effects, and Cochrane Central Register of Controlled Trials for relevant English-language studies published through September 2018. Surveillance continued through July 2019. STUDY SELECTION Trials of AAA screening benefits and harms; trials and cohort studies of small (3.0-5.4 cm) AAA treatment benefits and harms. DATA EXTRACTION AND SYNTHESIS Two investigators independently reviewed abstracts and full-text articles and extracted data. The Peto method was used to pool odds ratios (ORs) for AAA-related mortality, rupture, and operations; the DerSimonian and Laird random-effects model was used to pool calculated risk ratios for all-cause mortality. MAIN OUTCOMES AND MEASURES AAA and all-cause mortality; AAA rupture; treatment complications. RESULTS Fifty studies (N = 323 279) met inclusion criteria. Meta-analysis of population-based randomized clinical trials (RCTs) estimated that a screening invitation to men 65 years or older was associated with a reduction in AAA-related mortality over 12 to 15 years (OR, 0.65 [95% CI, 0.57-0.74]; 4 RCTs [n = 124 926]), AAA-related ruptures over 12 to 15 years (OR, 0.62 [95% CI, 0.55-0.70]; 4 RCTs [n = 124 929]), and emergency surgical procedures over 4 to 15 years (OR, 0.57 [95% CI, 0.48-0.68]; 5 RCTS [n = 175 085]). In contrast, no significant association with all-cause mortality benefit was seen at 12-to 15-year follow-up (relative risk, 0.99 [95% CI 0.98-1.00]; 4 RCTs [n = 124 929]). One-time screening was associated with significantly more procedures over 4 to 15 years in the invited group compared with the control group (OR, 1.44 [95% CI, 1.34-1.55]; 5 RCTs [n = 175 085]). Four trials (n = 3314) of small aneurysm surgical treatment demonstrated no significant difference in AAA-related mortality or all-cause mortality compared with surveillance over 1.7 to 12 years. These 4 early surgery trials showed a substantial increase in procedures in the early surgery group. For small aneurysm treatment, registry data (3 studies [n = 14 424]) showed that women had higher surgical complications and postoperative mortality compared with men. CONCLUSIONS AND RELEVANCE One-time AAA screening in men 65 years or older was associated with decreased AAA-related mortality and rupture rates but was not associated with all-cause mortality benefit. Higher rates of elective surgery but no long-term differences in quality of life resulted from screening.

The integrated screening action model (I-SAM): A theory-based approach to inform intervention development

“…Screening can reduce deaths if the people invited participate ( Ronco et al, 2014 , Myers et al, 2015 , National Lung Screening Trial Research Team, 2011 , Lin et al, 2016 , Guirguis-Blake et al, 2019 , Leese et al, 2015 ). Future technological advances will lead to more accurate, and stratified screening tests, offering improvements in early diagnosis and survival.…”

Cost-effectiveness of a population-based AAA screening program for men over 65 years old in Iran

“…More recently, the results of a systematic review study commissioned by the United States Preventive Services Task Force showed that 1-time AAA screening in men 65 years or older was associated with decreased AAA-related mortality and rupture rates and increased rates of elective surgery, but it was not associated with all-cause mortality benefits and long-term differences in the quality of life resulting from screening [ 54 ]. Based on these findings, the said task force recommended 1-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked and selective screening for AAA with ultrasonography in men aged 65 to 75 years who have never smoked rather than routinely screening all men in this group [ 55 ].…”

Screening for Abdominal Aortic Aneurysms and Risk Factors in 65-Year-Old Men in Oslo, Norway

“…Ultrasonography of the abdominal aorta is a highly sensitive and specific modality for detection of AAAs. 11,27,28 The screening team works at the Department of Vascular Surgery and the Department of Radiology and Interventional Radiology at Oslo University Hospital, and the costs were shared between these two departments. The screening project has no external funding.…”

“…[6][7][8][9] Several large studies have shown that one-time ultrasound screening in men above 65 years reduces the incidence of sudden AAA ruptures and aneurysm-related mortality. [9][10][11][12][13][14][15] Consequently, Sweden (2006) and the United Kingdom (2009) have implemented national screening programs for ultrasonographic detection of AAA. 9,16 In the United States, one-time screening for AAA has been offered since 2007 to male members of Medicare between the ages of 65 to 75 years with any history of smoking.…”