Abdominal aortic aneurysm screening: are those at high-risk being overlooked?

Abstract

An abdominal aortic aneurysm (AAA) is defined as enlargement of an abdominal aorta with a diameter of 3.0 cm or larger in the anteroposterior or transverse plane. In order to diagnose and treat this disease early, clinical trials were conducted to evaluate the benefits of ultrasound screening for AAA. There is enough good evidence to recommend AAA population ultrasound scan screening for men over 65 years old. Prevalence rates for AAA amongst males at age 65 detected by screening appear to be decreasing, however AAA screening continues to be cost effective. There has been emerging evidence suggesting a strong link between family history and development of AAA. The prevalence of AAA amongst family members has been higher when compared to general population. This high prevalence of AAA in the first-degree relatives provide a strong argument for aggressive approach to screening of this specific cohort. After the latest literature review, there have been no data from a single randomised clinical trial or large nonrandomised studies published with ‘targeted USS screening’ with regards to family history of AAA. Ultrasound screening for the first-degree relatives, both male and female, of patients with AAA appears to be feasible and cost effective. A pilot study to determine the prevalence of familial AAA amongst probands and the prevalence amongst first degree relatives should identify the unmet need for AAA screening for this cohort and quantify the resources required for a sustainable screening programme.