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

Abstract

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.

Screening Older Adult Men for Abdominal Aortic Aneurysm: A Scoping Review

“…AAA can be reliably diagnosed with imaging modalities including ultrasonography ( Benson et al, 2018 ). Ultrasound has a high specificity (almost 100%) and sensitivity (95%) for visualizing the aorta and detecting AAA ( Keisler & Carter, 2015 ).…”

“…An AAA diameter of 5.5 cm or greater is used as a threshold for surgical repair of AAA to prevent rAAA ( Keisler & Carter, 2015 ; LeFevre, 2014 ). The leading options for AAA repair are open surgical repair and endovascular aneurysm repair (EVAR) ( Benson et al, 2018 ; Carino et al, 2018 ). Both surgical methods are used for the elective repair of large AAAs and the emergent repair of rAAAs ( Keisler & Carter, 2015 ).…”

“…To date, there are no provincial or federal AAA screening programs for men in Canada ( Ali et al, 2016 ). Men’s participation in international AAA screening programs varies significantly; in the United Kingdom and Sweden, participation is approximately 80% for older men ( Benson et al, 2018 ; Zarrouk et al, 2013 ). Interestingly, the United States, the United Kingdom, and Sweden all have AAA screening programs for eligible men; yet participation rates are significantly lower in the United States.…”

“…The three major pathogenic theories include inflammation, proteolysis (protein degradation), and vascular smooth muscle apoptosis (programmed cell death) ( Powell, 2007 ). Risk factors for AAA development include male sex, older age, tobacco use, family history, European ancestry, hypertension, hypercholesteremia, and history of other large vessel aneurysms ( Benson et al, 2018 ; Carino et al, 2018 ; Cornuz et al., 2004 ; Wanhainen et al, 2020 ). There are conflicting data about atherosclerosis and obesity as risk factors for AAA development ( Carino et al, 2018 ).…”

Optimising fitness for major vascular surgery

“…More than 200 million people are affected by peripheral arterial disease worldwide,1 of whom 10-20% require surgery. In the UK, 1.2-1.5% of men over 65 have an abdominal aortic aneurysm, and more than 4000 repairs were performed in 2017 23. Between 7% and 18% of ischaemic strokes are attributed to carotid artery stenosis.…”