Screening for abdominal aortic aneurysms in Canada: 2020 review and position statement of the Canadian Society for Vascular Surgery

Abstract

Abdominal aortic aneurysms (AAAs) remain a major risk to patients, despite level 1 evidence for screening to prevent rupture events and decrease mortality. In 2007, the Canadian Society for Vascular Surgery (CSVS) published a review and position statement for AAA screening in Canada. Since that publication, there have been a number of updates in the published literature affecting screening recommendations. In this paper, we present a review of some of the controversies in the AAA screening literature to help elucidate differences in the various published screening guidelines. This article represents a review of the data and updated recommendations for AAA screening in the Canadian population on behalf of the CSVS. Les anévrismes de l’aorte abdominale (AAA) continuent de poser un risque majeur pour les patients, malgré des données probantes de niveau 1 à l’appui du dépistage pour prévenir les ruptures et réduire la mortalité. En 2007, la Société canadienne de chirurgie vasculaire (SCCV) a publié une revue et un énoncé de position sur le dépistage de l’AAA au Canada. Depuis lors, plusieurs mises à jour ont paru dans la littérature et elles ont un impact sur les recommandations relatives au dépistage. Dans le présent article, nous présentons une synthèse de quelques controverses soulevées dans la littérature sur le dépistage de l’AAA afin d’expliquer les différences entre les diverses lignes directrices publiées à ce sujet. Cet article propose au nom de la SCCV une revue des données probantes et des recommandations à jour sur le dépistage de l’AAA dans la population canadienne.

AAA Revisited: A Comprehensive Review of Risk Factors, Management, and Hallmarks of Pathogenesis

“…It is estimated that screening only male smokers between the ages of 65 and 75 leads to an AAA detection rate of about 30% in the population aged 50–84 [ 49 ]. While most current guidelines do not recommend population screenings for women, again mainly due to low prevalence and cost-effectiveness considerations [ 10 , 157 ], Canada has recently challenged this notion and proposed one-time screening by ultrasonography for women of advanced age with a history of smoking or cardiovascular disease [ 167 ]. No assessments of feasibility and cost-effectiveness have yet been performed for other candidate groups, such as patients with other peripheral aneurysms [ 168 ], cardiovascular diseases [ 113 , 169 ], or a subaneurysmal aortic dilation (2.5–2.9 cm in diameter) [ 32 , 170 ].…”

Impact of an emergency endovascular aneurysm repair protocol on 30-day ruptured abdominal aortic aneurysm mortality

“…35,36 Notable studies on the efficacy of AAA screening and the subsequent introduction of screening guidelines from the Canadian Society of Vascular Surgery, Society of Vascular Surgery, and European Society of Vascular Surgery, may contribute to the decreasing incidence of rAAA. 34,[37][38][39] Despite the decreasing incidence of rAAA, patients captured in this retrospective review were more often unstable after EVAR became widely available for the treatment of rAAA with the introduction of the emergency EVAR protocol. To the authors' knowledge, this finding has not been demonstrated in the previous literature.…”

The Canadian Women’s Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women — Chapter 5: Sex- and Gender-Unique Manifestations of Cardiovascular Disease

“…Although AAA ultrasound screening recommendations are available, studies for AAA screening have notoriously under-represented women, undermining the evidence to guide screening practices in women. 181 The CCS, Canadian Society of Vascular Surgery, and Society of Vascular Surgery recommend screening women for AAA if they have smoked, have heart disease, have a family history of AAA, and are between the ages of 65 and 80 years. 179 …”