Recommendations on screening for abdominal aortic aneurysm in primary care

Abstract

KEY POINTS• Pooled analyses from four population-based RCTs with men older than 65 years show that one-time screening with ultrasonography for AAA reduces the risk of aneurysm-related death, rupture and emergency repair.• Screening leads to identification of aneurysms that would not dilate or rupture, and increases the likelihood of elective repair procedures for these patients.• A weak recommendation in favour of screening suggests the importance of shared decision-making with the primary care provider and patient, with discussion of patient preferences for screening.• The prevalence of AAA in screened populations has declined since the RCTs were conducted, reducing the absolute benefit of screening.• Women have much lower rates of AAA than men, and there is no direct evidence that screening women has a positive impact on their health.• Evidence on the impact of AAA screening on men older than 80 years of age is indirect, meaning any potential benefit is uncertain. CPD

Global Burden of Aortic Aneurysm and Attributable Risk Factors from 1990 to 2017

“…The favorable pattern of the obvious downward trend of ASRs may reflect the benefits of robust health systems that are stemming AA burden via risk factor modulation. In addition, improvements in treatment [21] and supportive nursing measures [19] in recent years have further promoted this trend [22,23]. These findings provide clear confirmation that AA prevention can no longer be a priority of only well developed areas.…”

“…Those countries are also more likely to consider AA as a high priority in disease-prevention programs. For example, UK [17], Sweden [18], America [19], and Canada [20] adopted national screening policies, which undoubtedly saves lives and alleviates the AA burden imposed on medical healthcare systems. Furthermore, we found positive associations between EAPC and HDI in 2017 at the beginning while negative associations were observed when the HDI exceeded about 0.8 (the 'very high' level).…”

Appraisal of transthoracic echocardiography for opportunistic screening of abdominal aortic aneurysm

“…Most widely used guidelines are published by the Canadian Task Force on Preventive Health Care, the Canadian Society for Vascular Surgery, the US Preventive Services Task Force, the American College of Cardiology and American Heart Association, the European Society for Vascular Surgery, and the Society for Vascular Surgery. [ 8 , 26 – 30 ] Based on the criteria reported by these organizations about the screening of AAA, we categorized our cases and evaluated how many of them met the reported criteria. Accordingly, mostly the criteria about screening men over 65 years of age were met in our study group, and the criteria about screening women were not adequately met by our cases.…”

Evaluating the Use of a Generic Three-Dimensionally (3D) Printed Abdominal Aortic Aneurysm Model as an Adjunct Patient Education Tool

“…Studies evaluating the patient perspective could be a potential next step. The advantage of using generic 3D AAA models over patient-specific ones is the lower cost associated with using these models, considering the fact that close to 20,000 Canadians are diagnosed with an AAA each year [8]. It is estimated that the first print of the model used in this project costs 142.85tomakeandcouldbeusedindefinitelyifonlydonesoforpatientinformationandtoobtaininformedconsent.…”

“…The enlarged section of the artery is highly susceptible to rupture without warning, which leads to massive internal bleeding and mortality rates close to 90% [5,6]. A total of 20,000 Canadians are estimated to be diagnosed with a AAA each year, and approximately 1,244 deaths linked to such conditions were reported in Canada between 2009 and 2013 [7,8]. To prevent the rupture of a AAA, a procedure called endovascular aortic repair stent grafting (EVAR) is performed.…”