Preventing Death from Abdominal Aortic Aneurysm Rupture

This review considers the evidence for screening patients for abdominal aortic aneurysms (AAA). It describes how there was initial scepticism about screening asymptomatic patients, as there was a lack of knowledge about the incidence and natural history of patients with AAAs. Similarly, there was no consensus as to who to screen and when to operate. Additionally, no effective long-term measure for cost-effectiveness for such a screening programme had been demonstrated. After a literature search, 22 articles were selected for further review. Relevant guidelines, review articles, and randomised controlled studies were included. Several studies assessed when and why to consider intervention for asymptomatic AAAs. Other studies have identified possible target groups within the general population with a higher incidence of AAAs for screening. Ultrasonography was the agreed modality routinely used for screening in all the studies. Most studies supported the benefits for screening male patients above the age of 64 years. And, there is now also growing evidence of the cost-effectiveness of screening programmes that take into account quality adjusted life years (QALYs) gained. This review presents experiences from different countries on implementing screening programmes for AAAs. There is currently sufficient evidence to demonstrate that a targeted and coordinated screening programme for AAAs can be both life-saving and cost-effective in the long-term.