Five Year Natural History of Screening Detected Sub-Aneurysms and Abdominal Aortic Aneurysms in 70 Year Old Women and Systematic Review of Repair Rate in Women

Söderberg, Patrik; Wanhainen, Anders; Svensjö, Sverker

doi:10.1016/j.ejvs.2017.02.024

Cited by 19 publications

(9 citation statements)

References 41 publications

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“…Two reviewers evaluated 3946 citations and 137 full-text articles against inclusion criteria, and 33 studies (69 articles) met inclusion criteria for this systematic review (Figure 2). Nine new studies were included (4 RCTs, 2 cohort studies, and 3 registry studies) and 24 studies (13 RCTs, 8 cohort studies, 1 case-control study, and 2 registry studies) were carried forward from the previous USPSTF report.…”

Section: Resultsmentioning

confidence: 99%

“…No trial-level evidence examined the effectiveness of 1-time screening plus rescreening compared with 1-time screening alone. Seven cohort studies (5 fair-quality, 2 good-quality) and 1 fair-quality case-control study recruited screen-negative participants (AAA diameter 2.5-2.9 cm or 2.6-2.9 cm, <2.5 cm, or ≤3 cm) and administered various rescreening protocols (rescreening every 1 to 5 years with 1 to 6 repeated scans), reporting the proportion of initially screen-negative aortas that reached 5.0 or 5.5 cm at the repeat scan (eTables 2 and 3 in the Supplement). This group of heterogeneous studies reported that AAA-related mortality over 5 to 12 years was rare (<3%) among participants with normal aortas (<3 cm) on the initial scan.…”

Section: Resultsmentioning

confidence: 99%

“…This group of heterogeneous studies reported that AAA-related mortality over 5 to 12 years was rare (<3%) among participants with normal aortas (<3 cm) on the initial scan. On rescreening, few aortas (0%-2%) grew to larger than 5 cm at 5 years, and 0% to 15% had progressed at 10 years (eTable 2 in the Supplement). Four studies reported no AAA ruptures or AAA-related deaths at 4- to 5-year follow-up; 1 population screening program reported 2.4% ruptures at 7.9-year median follow-up (eTable 2 in the Supplement).…”

Section: Resultsmentioning

confidence: 99%

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Primary Care Screening for Abdominal Aortic Aneurysm

Guirguis-Blake

Beil

Senger

et al. 2019

JAMA

130

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IMPORTANCE Ruptured abdominal aortic aneurysms (AAAs) have mortality estimated at 81%. OBJECTIVE To systematically review the evidence on benefits and harms of AAA screening and small aneurysm treatment to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed (publisher supplied only), Database of Abstracts of Reviews of Effects, and Cochrane Central Register of Controlled Trials for relevant English-language studies published through September 2018. Surveillance continued through July 2019. STUDY SELECTION Trials of AAA screening benefits and harms; trials and cohort studies of small (3.0-5.4 cm) AAA treatment benefits and harms. DATA EXTRACTION AND SYNTHESIS Two investigators independently reviewed abstracts and full-text articles and extracted data. The Peto method was used to pool odds ratios (ORs) for AAA-related mortality, rupture, and operations; the DerSimonian and Laird random-effects model was used to pool calculated risk ratios for all-cause mortality. MAIN OUTCOMES AND MEASURES AAA and all-cause mortality; AAA rupture; treatment complications. RESULTS Fifty studies (N = 323 279) met inclusion criteria. Meta-analysis of population-based randomized clinical trials (RCTs) estimated that a screening invitation to men 65 years or older was associated with a reduction in AAA-related mortality over 12 to 15 years (OR, 0.65 [95% CI, 0.57-0.74]; 4 RCTs [n = 124 926]), AAA-related ruptures over 12 to 15 years (OR, 0.62 [95% CI, 0.55-0.70]; 4 RCTs [n = 124 929]), and emergency surgical procedures over 4 to 15 years (OR, 0.57 [95% CI, 0.48-0.68]; 5 RCTS [n = 175 085]). In contrast, no significant association with all-cause mortality benefit was seen at 12-to 15-year follow-up (relative risk, 0.99 [95% CI 0.98-1.00]; 4 RCTs [n = 124 929]). One-time screening was associated with significantly more procedures over 4 to 15 years in the invited group compared with the control group (OR, 1.44 [95% CI, 1.34-1.55]; 5 RCTs [n = 175 085]). Four trials (n = 3314) of small aneurysm surgical treatment demonstrated no significant difference in AAA-related mortality or all-cause mortality compared with surveillance over 1.7 to 12 years. These 4 early surgery trials showed a substantial increase in procedures in the early surgery group. For small aneurysm treatment, registry data (3 studies [n = 14 424]) showed that women had higher surgical complications and postoperative mortality compared with men. CONCLUSIONS AND RELEVANCE One-time AAA screening in men 65 years or older was associated with decreased AAA-related mortality and rupture rates but was not associated with all-cause mortality benefit. Higher rates of elective surgery but no long-term differences in quality of life resulted from screening.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Primary Care Screening for Abdominal Aortic Aneurysm

Guirguis-Blake

Beil

Senger

et al. 2019

JAMA

130

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“…Those with aortas between 2.5 cm and 2.9 cm were booked for a 5-year follow-up aortic ultrasound scan at their regional hospital vascular unit. The long-term clinical benefit of surveillance in this ‘sub-aneurysmal’ group is unknown but some studies have demonstrated a significant proportion will become aneurysmal within 5 years 22 . Women diagnosed with an AAA from 3.0–5.4 cm were offered cardiovascular risk factor modification advice, provided with an appointment with the local vascular unit for clinical assessment, and entered into follow-up with the local vascular surgery service.…”

Section: Methodsmentioning

confidence: 99%

Ultrasound screening for abdominal aortic aneurysm in high-risk women

Duncan

Maslen

Gibson

et al. 2021

British Journal of Surgery

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Background Population-wide ultrasound screening programmes for abdominal aortic aneurysm (AAA) for men have already been established in some countries. Women account for one third of aneurysm-related mortality and are four times more likely to experience an AAA rupture than men. Whole-population screening for AAA in women is unlikely to be clinically or economically effective. The aim of this study was to determine the outcomes of a targeted AAA screening programme for women at high risk of AAA. Method Women aged 65–74 years deemed at high risk of having an AAA (current smokers, ex-smokers, or with a history of coronary artery disease) were invited to attend ultrasound screening (July 2016 to March 2019) for AAA in the Female Aneurysm screening STudy (FAST). Primary outcomes were attendance for screening and prevalence of AAA. Biometric data, medical history, quality of life (QoL) and aortic diameter on ultrasound imaging were recorded prospectively. Results Some 6037 women were invited and 5200 attended screening (86.7 per cent). Fifteen AAAs larger than 29 mm were detected (prevalence 0.29 (95 per cent c.i. 0.18 to 0.48) per cent). Current smokers had the highest prevalence (0.83 (95 per cent c.i. 0.34 to 1.89) per cent) but lowest attendance (75.2 per cent). Three AAAs greater than 5.5 cm were identified and referred for consideration of surgical repair; one woman underwent repair. There was a significant reduction in patient-reported QoL scores following screening. Conclusion A low prevalence of AAA was detected in high-risk women, with lowest screening uptake in those at highest risk. Screening for AAA in high-risk women may not be beneficial.

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“…53 The debate extends to follow-up of women with sub-aneurysmal aortas, in whom an equally high proportion will go on to reach threshold for surgery. 54 Current uptake in screening is approximately 80% in the NAAASP, with regular review to improve access and coverage. Turn down rates during the Chichester trial were higher in the older age group (33.8% for subjects aged 76-80 years vs 19.5% for those aged 65 years).…”

Section: Challenges and Controversiesmentioning

confidence: 99%

Ultrasound screening for abdominal aortic aneurysm: current practice, challenges and controversies

Benson

Meecham

Fisher

et al. 2018

BJR

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The UK screening programme began in 2009, and has now been expanded around the UK. Long-term follow-up of the original cohorts continues to demonstrate significant benefits for abdominal aortic aneurysm (AAA)-related and all-cause mortality , and results from the first 5 years of the formal screening programme have demonstrated similar success. Ultrasound scanning is an effective and safe screening tool for the detection of AAA, although a variety of measurement protocols are employed internationally. Key challenges for the future of the programme relate to declining incidence of screen detected aneurysms. Recent publications have demonstrated a UK incidence of only 1.34%, compared to 4.9-7.2% of men invited for screening in the original trials. Work into increasing engagement amongst the target group, and expanding screening to siblings and women is underway to address this issue. This review describes the evidence behind the screening programme, its justification in addressing AAA as a significant health problem and discusses some of the potential developments in the future.

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Five Year Natural History of Screening Detected Sub-Aneurysms and Abdominal Aortic Aneurysms in 70 Year Old Women and Systematic Review of Repair Rate in Women

Cited by 19 publications

References 41 publications

Primary Care Screening for Abdominal Aortic Aneurysm

Primary Care Screening for Abdominal Aortic Aneurysm

Ultrasound screening for abdominal aortic aneurysm in high-risk women

Ultrasound screening for abdominal aortic aneurysm: current practice, challenges and controversies

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