Display options
Cite
Ultrasound screening for abdominal aortic aneurysm: an evidence-based analysis. Ont Health Technol Assess Ser. 2006;6(2):1-67
(2006). Ultrasound screening for abdominal aortic aneurysm: an evidence-based analysis. Ontario health technology assessment series, 6(2), 1-67.
"Ultrasound screening for abdominal aortic aneurysm: an evidence-based analysis." Ontario health technology assessment series vol. 6,2 (2006): 1-67.
Ultrasound screening for abdominal aortic aneurysm: an evidence-based analysis. Ont Health Technol Assess Ser. 2006;6(2):1-67. Epub 2006 Jan 01. PMID: 23074490; PMCID: PMC3379169.
Copy Download .nbib Format: NLM
Share it on

Ont Health Technol Assess Ser. 2006;6(2):1-67. Epub 2006 Jan 01.

Ultrasound screening for abdominal aortic aneurysm: an evidence-based analysis.

Ontario health technology assessment series

[No authors listed]

PMID: 23074490 PMCID: PMC3379169

Abstract

OBJECTIVE: The aim of this review was to assess the effectiveness of ultrasound screening for asymptomatic abdominal aortic aneurysm (AAA).

CLINICAL NEED: Abdominal aortic aneurysm is a localized abnormal dilatation of the aorta greater than 3 cm. In community surveys, the prevalence of AAA is reported to be between 2% and 5.4%. Abdominal aortic aneurysms are found in 4% to 8% of older men and in 0.5% to 1.5% of women aged 65 years and older. Abdominal aortic aneurysms are largely asymptomatic. If left untreated, the continuing extension and thinning of the vessel wall may eventually result in rupture of the AAA. Often rupture may occur without warning, causing acute pain. Rupture is always life threatening and requires emergency surgical repair of the ruptured aorta. The risk of death from ruptured AAA is 80% to 90%. Over one-half of all deaths attributed to a ruptured aneurysm take place before the patient reaches hospital. In comparison, the rate of death in people undergoing elective surgery is 5% to 7%; however, symptoms of AAA rarely occur before rupture. Given that ultrasound can reliably visualize the aorta in 99% of the population, and its sensitivity and specificity for diagnosing AAA approaches 100%, screening for aneurysms is worth considering as it may reduce the incidence of ruptured aneurysms and hence reduce unnecessary deaths caused by AAA-attributable mortality.

REVIEW STRATEGY: The Medical Advisory Secretariat used its standard search strategy to retrieve international health technology assessments and English-language journal articles from selected databases to determine the effectiveness of ultrasound screening for abdominal aortic aneurysms. Case reports, letters, editorials, nonsystematic reviews, non-human studies, and comments were excluded. Questions asked: Is population-based AAA screening effective in improving health outcomes in asymptomatic populations?Is AAA screening acceptable to the population? Does this affect the effectiveness the screening program?How often should population-based screening occur?What are appropriate treatment options after screening based on the size of aneurysms?Are there differences between universal and targeted screening strategies?What are the harms of screening?

SUMMARY OF FINDINGS: Population-based ultrasound screening is effective in men aged 65 to 74 years, particularly in those with a history of smoking. Screening reduces the incidence of AAA ruptures, and decreases rates of emergency surgical repair for AAA and AAA-attributable mortality.Acceptance rates decline with increasing age and are lower for women. Low acceptance rates may affect the effectiveness of a screening program.A one-time screen is sufficient for a population-based screening program with regard to initial negative scans and development of large AAAs.There is no difference between early elective surgical repair and surveillance for small aneurysms (4.0-5.4 cm). Repeated surveillance of small aneurysms is recommended.Targeted screening based on history of smoking has been found to detect 89% of prevalent AAAs and increase the efficiency of screening programs from statistical modeling data.Women have not been studied for AAA screening programs. There is evidence suggesting that screening women for AAA should be considered with respect to mortality and case fatality rates in Ontario. It is important that further evaluation of AAAs in women occur.There is a small risk of physical harm from screening. Less than 1% of aneurysms will not be visualized on initial screen and a re-screen may be necessary; elective surgical repair is associated with a 6% operative morality rate and about 3% of small aneurysms may rupture during surveillance. These risks should be communicated through informed consent prior to screening.There is little evidence of severe psychological harms associated with screening.

CONCLUSIONS: Based on this review, the Medical Advisory Secretariat concluded that there is sufficient evidence to determine that AAA screening using ultrasound is effective and reduces negative health outcomes associated with the condition. Moreover, screening for AAA is cost-effective, comparing favorably for the cost of per life year gained for screening programs for cervical cancer, hypertension, and breast cancer that are in practice in Ontario, with a high degree of compliance, and can be undertaken with a minimal effort at fewer than 10 minutes to screen each patient. Overall, the clinical utility of an invitation to use ultrasound screening to identify AAA in men aged 65 to 74 is effective at reducing AAA-attributable mortality. The benefit of screening women is not yet established. However, Ontario data indicate several areas of concern including population prevalence, detection of AAA in women, and case management of AAA in women in terms of age cutoffs for screening and natural history of disease associated with age of rupture.

References

  1. Eur J Vasc Endovasc Surg. 2000 Jul;20(1):79-83 - PubMed
  2. Br J Surg. 1994 Aug;81(8):1112-3 - PubMed
  3. Chronic Dis Can. 1996 Spring;17(2):51-5 - PubMed
  4. Mayo Clin Proc. 2000 Apr;75(4):395-9 - PubMed
  5. J Med Screen. 2002;9(3):125-7 - PubMed
  6. Eur J Public Health. 2004 Dec;14(4):343-9 - PubMed
  7. BMJ. 2005 Apr 2;330(7494):750 - PubMed
  8. Eur J Vasc Endovasc Surg. 2002 Jan;23(1):55-60 - PubMed
  9. Ann Intern Med. 1989 Feb 1;110(3):214-26 - PubMed
  10. Med J Aust. 2000 Oct 2;173(7):345-50 - PubMed
  11. J Vasc Surg. 2003 Oct;38(4):739-44 - PubMed
  12. J Vasc Surg. 2005 May;41(5):741-51; discussion 751 - PubMed
  13. BMJ. 1998 Aug 1;317(7154):307-12 - PubMed
  14. Lancet. 1998 Nov 21;352(9141):1649-55 - PubMed
  15. J Vasc Surg. 2001 Jun;33(6):1139-47 - PubMed
  16. J Vasc Surg. 2000 Dec;32(6):1091-100 - PubMed
  17. Surg Clin North Am. 1989 Aug;69(4):713-20 - PubMed
  18. J Public Health Med. 1998 Jun;20(2):211-7 - PubMed
  19. Ann Intern Med. 1997 Mar 15;126(6):441-9 - PubMed
  20. Surgery. 2002 Aug;132(2):399-407 - PubMed
  21. Ann Intern Med. 1999 Apr 20;130(8):637-42 - PubMed
  22. J Vasc Surg. 2003 Oct;38(4):745-52 - PubMed
  23. J Vasc Surg. 2003 May;37(5):1106-17 - PubMed
  24. Eur J Vasc Endovasc Surg. 1997 Dec;14(6):499-501 - PubMed
  25. Eur J Vasc Endovasc Surg. 2001 Jun;21(6):535-40 - PubMed
  26. J Vasc Surg. 1999 Aug;30(2):203-8 - PubMed
  27. Lancet. 2002 Nov 16;360(9345):1531-9 - PubMed
  28. Clin Invest Med. 2002 Aug;25(4):127-33 - PubMed
  29. ANZ J Surg. 2004 Dec;74(12):1069-75 - PubMed
  30. Lancet. 1998 Nov 21;352(9141):1656-60 - PubMed
  31. Gerontology. 2004 Nov-Dec;50(6):349-59 - PubMed
  32. N Engl J Med. 2002 May 9;346(19):1437-44 - PubMed
  33. Br J Surg. 1995 Aug;82(8):1066-70 - PubMed
  34. Ann Vasc Surg. 2004 May;18(3):287-93 - PubMed
  35. Eur J Vasc Endovasc Surg. 2003 Jul;26(1):74-80 - PubMed
  36. BMJ. 2004 Jun 19;328(7454):1490 - PubMed
  37. J Vasc Surg. 1994 Dec;20(6):914-23; discussion 923-6 - PubMed
  38. Ann Intern Med. 2005 Feb 1;142(3):198-202 - PubMed
  39. BMJ. 2004 Nov 27;329(7477):1259 - PubMed
  40. J Med Screen. 2004;11(1):50-3 - PubMed
  41. Br J Surg. 2002 Mar;89(3):283-5 - PubMed
  42. BMJ. 2002 Nov 16;325(7373):1135 - PubMed
  43. Arch Intern Med. 2000 May 22;160(10):1425-30 - PubMed
  44. IEEE Trans Med Imaging. 2005 Apr;24(4):477-85 - PubMed
  45. Br J Surg. 2001 Jul;88(7):941-4 - PubMed
  46. Arch Intern Med. 2000 Mar 27;160(6):833-6 - PubMed

Publication Types