The role of ultrasound screening in reducing AAA mortality: a review

Abstract

Background: Men aged 65Á79 are at the highest risk of having an abdominal aortic aneurysm (AAA) as well as a high incidence of rupture; this is treated as a surgical emergency, which has a total mortality of 75Á90%. 1Á5 The diameter of an AAA proves to be the most useful risk factor in predicting mortality rates. 6,7 Ultrasonography is widely accepted as an effective diagnostic imaging tool for detecting AAA. 8 Based on this, AAA elective repair is recommended to individuals with AAA of diameter ]55 mm. 6,7 The problem lies in detecting individuals with AAA as many are asymptomatic. 9 The aim of this article is to determine whether a population-based ultrasound screening programme can significantly reduce AAA mortality using the critical appraisal skills programme (CASP) tool. Method: Databases were searched for relevant literature. Studies were limited to randomised controlled trials (RCTs) that conducted a population-based screening programme using ultrasound. The results were further refined using inclusion and exclusion criteria. Four RCTs were selected for review. Results: The pooled results of 125,576 men showed a significant reduction in the incidence of ruptured AAAs and AAA-related mortality in the intervention group. There was an insignificant reduction in all-cause mortality, and a significant increase in surgical rates in the intervention group. One of the reviewed studies looked at the effects of screening on 9,342 women and reported an insignificant reduction in AAA-related mortalities, all-cause mortality, and ruptured incidence. Conclusion: There is evidence that a population-based screening has a significant effect in reducing AAA-related mortality in males aged 65Á74. Due to the paucity of evidence in current available literature, no definitive conclusions can be drawn regarding population-based screening for AAA in women; it is suggested that future studies should be carried out to assess the benefits and relative risks of screening for this population.