Abdominal Aortic Aneurysm Screening: Do We Need to Shift Toward a Targeted Strategy?

Abstract

Several abdominal aortic aneurysm (AAA) screening programs have been developed worldwide, aiming at early identification of individuals with an unknown AAA. 1 This became possible because of the high accuracy (sensitivity and specificity of nearly 100%) of duplex scan, a noninvasive investigation performed by portable scanners. 2 Early detection of AAA allows a timely elective repair leading to a reduced AAA-related mortality and complications associated with an urgent intervention. 3,4 A recent systematic evidence review for the US Preventive Services Task Force suggested that onetime invitation for AAA screening in men aged 65 years or older was associated with decreased AAA rupture and AAA-related mortality rates. 5 Another study highlighted the significant risk of AAA patients for developing cardiovascular (CV) events and thus the identification of those patients even with small AAA may contribute to CV risk reduction. 6 A recent meta-analysis showed that invitation to AAA screening in 64-year-old men significantly reduced both all-cause and AAA-related mortality. 7 The Society for Vascular Surgery (SVS) has recommended onetime duplex scan screening for AAAs in men aged 55 years or older with a family history of AAA, all men aged 65 years or older, and women aged 65 years or older who have smoked or have a family history of AAA. 8 In the United States, Medicare covers 1 ultrasound scan screening of men aged 65 to 75 years who ever smoked in their lifetime or men and women who have a family history of AAA disease as part of a "Welcome to Medicare" package. 9 The European Society for Vascular Surgery has recommended that men should be screened for AAAs with a single duplex scan at the age of 65 years or younger men who may be at increased risk (eg, those who smoke or have a family history). 10 On the other hand, although the American College of Preventive Medicine has recommended onetime screening in men aged 65 to 75 years who have ever smoked, it has not recommended routine screening in women. 11 Recent literature has highlighted the association of clinical factors with the increased incidence of AAA, which are not included in the indications of guidelines for AAA screening.A total of 22 studies involving 13 388 patients concluded that AAA prevalence was significantly higher in patients with coronary artery disease versus patients without (odds ratio [OR] 2.42, 95% confidence interval [CI], 2.08-2.81). 12 Another meta-analysis showed that serum low-density lipoprotein cholesterol is higher in patients with AAA (mean differences [MD], 0.25 mmol/L; 95% CI, 0.08-0.42 mmol/L; P ¼ .004) than control patients while the serum high-density lipoprotein cholesterol is likely lower. 13 Additionally, a significant association between AAA and other factors has been demonstrated, such as body mass index (OR 1.20; 95% CI, 1.17-1.22), 14 chronic obstructive pulmonary disease (adjusted OR 3.0; 95% CI 1.6-5.5, P < .001), 15 primary abdominal wall hernia (OR 2.32; 95% CI, 1.72-3.14; P for effect <.00001; P for heterogeneity <.0...

Screening Program of Abdominal Aortic Aneurysm

“…9 There are arguments to change from mass screening toward targeted screening for AAA in patients at risk (smoking history, family history, cardiovascular occlusive disease). 65…”

Prevention and Treatment of Ruptured Abdominal Aortic Aneurysms

“…19 A more targeted AAA screening program (eg, only ≥65-year-old male, ever-smokers) may currently be a more suitable strategy. 20…”