International Update on Screening for Abdominal Aortic Aneurysms: Issues and Opportunities

Björck, Martin; Bown, Matthew J.; Choke, E.; Earnshaw, J. J.; Flørenes, T; Glover, Matthew; Kay, Mark; Laukontaus, Sani; Lees, Tim; Lindholt, Jes Sanddal; Powell, J.T.; Rij, André van; Svensjö, Sverker; Wanhainen, Anders

doi:10.1016/j.ejvs.2014.08.015

Cited by 31 publications

(33 citation statements)

References 28 publications

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“…1 Independent risk factors for AAA include not only aging, but also male and smoking, 2–6 whereas some risk factors such as hypertension and hypercholesterolemia have not been consistently demonstrated to be independent risk factors. 3,7,8 There are several recent population studies have enhanced or extended insights into risk factors for AAA or associations with AAA.…”

Section: Abdominal Aortic Aneurysmsmentioning

confidence: 99%

Aortic Aneurysms

Lü

Daugherty

2017

ATVB

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Section: Abdominal Aortic Aneurysmsmentioning

confidence: 99%

Aortic Aneurysms

Lü

Daugherty

2017

ATVB

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“…2 Because most AAAs are asymptomatic, ultrasoundbased screening programs targeting risk groups (commonly men aged ≥65 years) have been established in some countries. 3 Such programs, along with the growing use of abdominal imaging for other problems, have led to an increase in the identification of patients with small AAAs. Predicting the progression of small AAAs is, therefore, a key management priority.…”

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confidence: 99%

Surrogate Markers of Abdominal Aortic Aneurysm Progression

Wanhainen

Mani

Golledge

2016

ATVB

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Abstract-The natural course of many abdominal aortic aneurysms (AAA) is to gradually expand and eventually rupture and monitoring the disease progression is essential to their management. In this publication, we review surrogate markers of AAA progression. AAA diameter remains the most widely used and important marker of AAA growth. Wanhainen et al Surrogate Markers of Aneurysm Progression 237in all studies when a standardized protocol is used. 7,8 One of the challenging aspects to assessing maximum AAA diameter is the variety of methods that can potentially be used and the lack of reporting of the exact techniques used in individual studies. Variations may occur in the plane of acquisition (eg, coronal or sagittal), the axis of measurement (eg, axial or orthogonal), the position of the measuring calipers (eg, inner to inner or outer to outer), the relationship with the cardiac cycle (systole versus diastole), and the selected region of the AAA. 9 It has been suggested that diameters measured perpendicular to the aorta centerline (orthogonal), rather than within the axial plane, are more representative of the true AAA diameter. 4,6 With ultrasound, measurements within the anteroposterior, rather than the transverse plane, have been reported to be more reproducible. 4 There is no current consensus on how to place the calipers when measuring the diameter with ultrasound. Methods used include the outer-to-outer method, where calipers are placed on the outer layer of the aortic wall; the inner-to-inner method, where calipers are placed on the inner layer of the aortic wall; and the leading edge-to-leading edge method, where calipers are placed on the outer layer of the anterior wall and the inner layer of the posterior wall ( Figure 1). Much of the reported variation in ultrasound measured AAA diameter is likely because of the variation in caliper placement. 5,10 The UK Small Aneurysm Trial 11 is based on the measurement of AAA diameter on the outer-to-outer method, and this method has been adopted into the current UK intervention criteria. 12 The inner-to-inner method was used in the Multicentre Aneurysm Screening Study, 13 and consequently it is used in the current UK National Health Service AAA screening programme.14 The leading edgeto-leading edge method is used in the current Swedish AAA screening programme.15 Studies comparing these methods show there is a significant difference in diameters measured with the different methods, which has an impact on the reported prevalence rates of AAA. 5,10 In a Swedish AAA screening study, the difference in mean diameter was 4 mm between inner-toinner and outer-to-outer, which resulted in an astonishing 77% difference in AAA prevalence (ie, 1.3% compared with 2.3%). 5A systematic review of 15 studies reported considerable variation in small AAA growth rates (mean, −0.3 to +4.0 mm/y). 15 The variation could not be explained by differences in initial AAA diameter alone. 16 The authors suggested that methodological issues, such as differences in imaging modalities, variation ...

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“…The prevalence threshold for cost-effectiveness of a screening program is considered to be 0.5–1.6% prevalence in 65-year old males from Western Countries [39]. Several studies collected AAA prevalence data from the general population, using a population-based study design or prevention intervention trials.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of abdominal aortic aneurysms and its relation with cardiovascular risk stratification: protocol of the Risk of Cardiovascular diseases and abdominal aortic Aneurysm in Varese (RoCAV) population based study

Gianfagna

Veronesi

Bertù

et al. 2016

BMC Cardiovasc Disord

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BackgroundRecent meta-analyses suggested that screening program for abdominal aortic aneurysms (AAA) in 65-year old males is cost-effective at prevalence of about 1%. Since some events occur also in females and among the youngers, screening could be feasible among those at higher risk, such as smokers or individuals with a family history of AAA. The RoCAV (Risk of Cardiovascular diseases and abdominal aortic Aneurysms in Varese) Project is a population-based study aimed to evaluate AAA prevalence in Northern Italy in males over-65 years as well as among females and younger males, and to identify new markers for risk stratification by collecting a large set of CVD risk factors. The aims of the project are: (i) cross-sectional evaluation of AAA prevalence (ii); evaluation of standard CVD risk score as criteria for selecting subgroup at higher risk to be included in a screening program; (iii) identification of new risk markers and risk score algorithm for AAA and CVD risk stratification; (iv) cost-effective evaluation during the follow-up.MethodsMales aged 50–75 years and females aged 60–75 years, resident in the city of Varese (Lombardy Region), were randomly selected from the civil registry. Among 5198 successfully invited, 3777 subjects accepted to participate and were finally recruited (participation rate 63.8%) from June 2013 to May 2016. Trained operators administered a computerized anamnestic questionnaire, measured anthropometric parameters (BMI, body circumferences, skinfolds), blood pressure, ankle-brachial index, pulse wave velocity and performed abdominal aortic ultrasound scan, ECG and spirometry. All methods were internationally validated. A blood sample was collected and stored in biobank. A follow-up will be carried out through linkage with electronic records.DiscussionParticipation rate and data quality assessment were as expected and will reasonably allow to reach the project aims. The expected impact in public health of the RoCAV project will be the potential implementation of a AAA screening program to the whole region as well as the formulation of new criteria for risk assessment of AAA and CVD.

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International Update on Screening for Abdominal Aortic Aneurysms: Issues and Opportunities

Cited by 31 publications

References 28 publications

Aortic Aneurysms

Aortic Aneurysms

Surrogate Markers of Abdominal Aortic Aneurysm Progression

Prevalence of abdominal aortic aneurysms and its relation with cardiovascular risk stratification: protocol of the Risk of Cardiovascular diseases and abdominal aortic Aneurysm in Varese (RoCAV) population based study

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