Randomisierte Studien mit EBM-Level 1 beweisen es: Ein Screeningprogramm für abdominelle Aortenaneurysmen ist sinnvoll!

Results have been published of randomised controlled studies on the screening of elderly men for abdominal aortic aneurysms (AAA). A systematic review and meta-analysis was therefore carried out in order to be able to assess the pooled effects. A Medline search (PubMed) for randomised controlled studies was carried out using the key words "screening" and "aortic aneurysms" in English. The medium-term (3.5-5 years) and long-term (7-15 years) effects were calculated as the odds ratio with a 95% confidence interval. Four studies were identified, the "Chichester Study" (UK/England), the "Multicentre Aneurysm Screening Study" (MASS) (UK/England), the "Western Australian Aneurysm Screening Study" (AUS) and the "Viborg Study" (Denmark). The analysis showed that the probability of an AAA rupture fell significantly by 47% as a result of screening, AAA-related mortality (after men over the age of 80 years were excluded) decreased by 49% and overall mortality was also reduced (OR 0.93; 95% CI: 0.90-0.96). The number of planned operations increased 3-fold (p<0.05) and the probability of emergency operations decreased by 45% (p<0.05). The long-term pooled results showed a significant reduction of 47% in the probability of both AAA rupture and AAA-related mortality and a significant decrease in overall mortality (OR 1.77; 95% CI: 0.92-0.97). Overall, 1.7 times more operations were carried out on the men invited for screening than on the controls (OR 1.77; 95% CI: 1.57; 1.99). AAA screening reduces the probability of rupture and AAA-related mortality by about 50% each and overall mortality by about 6-7%, although there are differences which might have an impact on local cost-benefit ratio of the screening.