Ultrasonographic screening for the detection of abdominal aortic aneurysms

TY - JOUR

T1 - Ultrasonographic screening for the detection of abdominal aortic aneurysms

AU - Eckstein, Hans-Henning

AU - Böckler, Dittmar

AU - Flessenkämper, Ingo

AU - Schmitz-Rixen, Thomas

AU - Debus, Sebastian

AU - Lang, Werner

PY - 2009/10

Y1 - 2009/10

N2 - BACKGROUND: The prevalence of abdominal aortic aneurysms (AAA) with a maximal diameter of 3 cm or more is age-dependent; among persons over age 65, it lies between 4% and 8% in men and between 0.5% and 1.5% in women. About 10% of all AAAs have a maximum diameter of 5 cm or more. The prognosis of ruptured AAA (rAAA) is dismal, with an overall mortality of at least 80%. Ultrasonography of the abdominal aorta is a safe and technically simple method of detecting AAAs.METHODS: Evaluation of population-based, randomized studies of ultrasonographic screening for the detection of AAA, based on a selective review of the literature.RESULTS: A meta-analysis of four randomized controlled studies showed that ultrasonographic screening was associated with a significant lowering of AAA-related mortality in men aged 65 to 80 after it had been performed for 3-5 years (risk reduction 44%, odds ratio [OR] 0.56, 95% confidence interval [CI] 0.44-0.72) and after it had been performed for 7-15 years (risk reduction 53%, OR 0.47, 95% CI 0.25-0.90). AAA screening was also associated with a significant lowering of the overall mortality after 7-15 years, but not in the first 5 years. Ultrasonographic screening led to a significant increase in the number of elective AAA operations performed and to a 50% reduction of the number of emergency operations for rAAA.CONCLUSION: Ultrasonographic screening for AAA is a technically simple diagnostic test that is associated with a major reduction of AAA-related mortality. In view of the higher prevalence of AAA among the elderly, it is recommended that all men aged 65 or older and all men and women with a family history of AAA should be systematically screened. A national ultrasound screening program should be urgently implemented in Germany in order to bring about a major reduction in AAA-associated mortality.

AB - BACKGROUND: The prevalence of abdominal aortic aneurysms (AAA) with a maximal diameter of 3 cm or more is age-dependent; among persons over age 65, it lies between 4% and 8% in men and between 0.5% and 1.5% in women. About 10% of all AAAs have a maximum diameter of 5 cm or more. The prognosis of ruptured AAA (rAAA) is dismal, with an overall mortality of at least 80%. Ultrasonography of the abdominal aorta is a safe and technically simple method of detecting AAAs.METHODS: Evaluation of population-based, randomized studies of ultrasonographic screening for the detection of AAA, based on a selective review of the literature.RESULTS: A meta-analysis of four randomized controlled studies showed that ultrasonographic screening was associated with a significant lowering of AAA-related mortality in men aged 65 to 80 after it had been performed for 3-5 years (risk reduction 44%, odds ratio [OR] 0.56, 95% confidence interval [CI] 0.44-0.72) and after it had been performed for 7-15 years (risk reduction 53%, OR 0.47, 95% CI 0.25-0.90). AAA screening was also associated with a significant lowering of the overall mortality after 7-15 years, but not in the first 5 years. Ultrasonographic screening led to a significant increase in the number of elective AAA operations performed and to a 50% reduction of the number of emergency operations for rAAA.CONCLUSION: Ultrasonographic screening for AAA is a technically simple diagnostic test that is associated with a major reduction of AAA-related mortality. In view of the higher prevalence of AAA among the elderly, it is recommended that all men aged 65 or older and all men and women with a family history of AAA should be systematically screened. A national ultrasound screening program should be urgently implemented in Germany in order to bring about a major reduction in AAA-associated mortality.

KW - Aortic Aneurysm, Abdominal/diagnostic imaging

KW - Female

KW - Humans

KW - Incidence

KW - Male

KW - Mass Screening/statistics & numerical data

KW - Prevalence

KW - Reproducibility of Results

KW - Risk Assessment/methods

KW - Risk Factors

KW - Sensitivity and Specificity

KW - Survival Analysis

KW - Survival Rate

KW - Ultrasonography/statistics & numerical data

U2 - 10.3238/arztebl.2009.0657

DO - 10.3238/arztebl.2009.0657

M3 - SCORING: Review article

C2 - 19946430

VL - 106

SP - 657

EP - 663

JO - DTSCH ARZTEBL INT

JF - DTSCH ARZTEBL INT

SN - 1866-0452

IS - 41

ER -