Journals Club - Abdominal aortic aneurysm screening

Contributed by Dr Louise Newson, a GP in the West Midlands

Screening for AAA is useful
Screening for AAA is useful

Key trials

  • The multicentre aneurysm screening study (MASS) involved more than 67,000 men and the results showed a 42 per cent RR reduction in mortality related to abdominal aortic aneurysm (AAA) after four years of follow up (Lancet 2002; 360: 1531-9).
  • A 10-year follow-up study from MASS has recently been published, showing that the RR reduction in mortality related to AAA screening is maintained (BMJ 2009; 338: b2307).
  • Results from a pilot study have shown that early screening for AAA in patients with IHD may be beneficial and could significantly alter their outcomes (Br J Cardiol 2009; 16: 231-5).

Evidence base

  • Although the overall mortality from AAA should be reduced, many small aneurysms will be detected and the number of patients requiring regular ultrasound review is likely to be large (BHF Factfile, Abdominal aortic aneurysms, 2008).
  • Although screening reduces aneurysm-related mortality, it has less of an effect on all-cause mortality (BMJ 2007; 335: 732-3).

Guidelines

  • The AAA screening programme began in 2009 and is expected to be England-wide by 2013. It will be phased in between 2011 and 2013 in Scotland; details for Wales and Northern Ireland need to be formalised.
  • The programme has estimated that for every 1,000 men invited to screening, 960 will have a normal scan, 35 will have a small aneurysm needing regular monitoring and only five will need surgery.

Key points

  • Screening for abdominal aortic aneurysm (AAA) has been shown to reduce AAA-related deaths in men.
  • NHS screening has started in England for men over 65 years.
  • Screening for AAA is cost effective.
  • Screening does not seem to reduce all-cause mortality.

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