Update on screening for abdominal aortic aneurysm: a topical review

Abstract

Objectives: Serving as the basis for implementation of several national AAA screening programmes, four large randomised controlled trials provided evidence of a reduction in AAA mortality by ultrasound-based screening among elderly men. Recently, reports of falling AAA prevalence and mortality unrelated to AAA screening have emerged, coinciding with major additional epidemiological changes in the population, as well as improvements in AAA repair. These recent changes may individually, and in concert, affect the rationality of AAA screening. The aim of this paper was to present an up-to-date review of AAA-screening within the context of a rapidly changing AAA epidemiology.

Methods: Topical review of the literature focusing mainly on randomised controlled trials, meta-analyses, and contemporary observational AAA-screening studies.

Conclusions: Summarising RCT results and recent studies; contemporary one-time screening of men for AAA appears highly cost-effective, and seems to remain an effective preventive health-measure. However, several issues regarding screening need to be addressed: most importantly; the current degree of incidental detection of AAAs, the threshold diameter for follow-up, targeted screening in risk groups, and the possible need for re-screening in an elderly population with ever increasing longevity.

Keywords: Abdominal aortic aneurysm; Epidemiology; Screening; Ultrasound; Vascular surgery.