Screening abdominal aorta aneurysm during echocardiography: Literature review and proposal for a French nationwide study

Abstract

Several international guidelines, including those in France, recommend the screening of abdominal aorta aneurysm (AAA) by ultrasound in high-risk populations. However, this preventive screening strategy is poorly implemented. Many patients who undergo transthoracic echocardiography (TTE) are at risk of AAA as defined by the guidelines, and the cardiac ultrasound machines and probes fit perfectly for AAA screening. In this literature review, we collected data from more than 20,000 patients who underwent screening for AAA during TTE, from 10 single-centre series. While the studies differed regarding patient selection and AAA definition, the feasibility of AAA screening during TTE was excellent (mostly >90%), with the need for an average of 2-7 minutes to be added to the cardiac imaging time. The prevalence of AAA >30 mm ranged from 0.8% to 6.5%, and up to 19% in men aged >70 years. The risk factors for the presence of AAA among attendees of echocardiography laboratories were similar to those reported in the general population: age, male gender, smoking, hypertension, family history of AAA and prevalent atherosclerotic diseases. Some echocardiography-specific factors, such as left ventricular hypertrophy or dilation and poor left ventricular ejection fraction were also reported. To better assess the benefit of and indications for AAA screening during TTE in clinical practice, we propose a multicentre, nationwide, screening study in echocardiography laboratories in our country.

Prevalence of abdominal aortic aneurysm in patients referred for transthoracic echocardiography

“…Age, male gender, cigarette smoking, hypertension and presence of atherosclerotic disease have been reported to be associated with AAA in general screening studies and echocardiographic series . In this study, we did not have records of systolic blood pressure or history of hypertension available.…”

“…Operative mortality after rupture is 40% to 50%, making overall mortality with rupture 80% to 90% . In the United States, it is estimated that 9000 people die each year from a ruptured AAA, which corresponds to approximately 12 000 cases in Europe …”

“…Ultrasound is the preferred screening mode because it is able to accurately identify AAA with sensitivity and specificity that approach 100% . Several international guidelines, recommend screening for AAA by ultrasound in high‐risk populations, however, this preventive screening strategy is poorly implemented …”

ACR Appropriateness Criteria® pulsatile abdominal mass, suspected abdominal aortic aneurysm

“…Screening for AAA can also be performed during unrelated imaging studies, such as transthoracic echocardiography [18, 19], peripheral vascular US [20], and imaging studies to assess coronary artery disease [21, 22] and stroke or transient ischemic attack [23]. …”

Aortic aneurysm screening

“…Much of this already occurs through community health practices assisted by sophisticated technological linkages and financial incentives to promote screening participation. In addition, patients attending cardiology services and vascular assessment laboratories have a higher prevalence of AAA and could be offered screening at the same point of contact.…”