Ultrasound screening for abdominal aortic aneurysm in high-risk women

Abstract

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.

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

“…The recently published Female Aneurysm Screening Study (FAST) from Leicester (2021) which adopted targeted screening approach for women (aged 65-74 years) with high risk factors (smoking or/and heart disease), concluded that in the population who attended screening, the prevalence of AAA among women with cardiovascular disease was 0.29% for AAA which is much lower than expected 0.35%, above which AAA screening seems to be effective. 37 A retrospective cohort study from France suggested ultrasound screening in women, especially with a positive family history where a first-degree relative is affected, has a prevalence of AAA in this cohort of 8.3%. 38 There are varying perspectives on recommendations for screening first degree relatives with regards to their age and sex.…”

Cellular, Molecular and Clinical Aspects of Aortic Aneurysm—Vascular Physiology and Pathophysiology

“…AAA is less common in women in the general population; however, this may be due to the fact that AAA in women is still underdiagnosed and undertreated. However women with AAA are now four times more likely to have a ruptured AAA compared to men of the same age and account for one third of deaths due to AAA ruptures [14]. Van de Luijtgaarden et al [15] examined patients with AAA invited to the multidisciplinary vascular/genetics outpatient clinic between 2009 and 2012 for an assessment of family history using questionnaires.…”

How best to diagnose and manage abdominal aortic aneurysms

“…15,18 Another recent trial of ultrasound screening in 5200 high-risk women ages 65 to 74 years found an AAA incidence of 0.29% (95% CI, 0.18%-0.48%) in which only 3 large aneurysms were identified. 22 In the United States, rates of screening for AAA remain low. 23 One study has shown electronic medical record-based reminders increased screening rates from 48% to 80%.…”