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Clinician Article

Ultrasonography screening for abdominal aortic aneurysms: a systematic evidence review for the U.S. Preventive Services Task Force.



  • Guirguis-Blake JM
  • Beil TL
  • Senger CA
  • Whitlock EP
Ann Intern Med. 2014 Mar 4;160(5):321-9. doi: 10.7326/M13-1844. (Review)
PMID: 24473919
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Disciplines
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 6/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 6/7
  • Internal Medicine
    Relevance - 6/7
    Newsworthiness - 6/7
  • Cardiology
    Relevance - 5/7
    Newsworthiness - 5/7
  • Public Health
    Relevance - 5/7
    Newsworthiness - 5/7
  • Surgery - Vascular
    Relevance - 5/7
    Newsworthiness - 5/7

Abstract

BACKGROUND: Long-term follow-up of population-based randomized, controlled trials (RCTs) has demonstrated that screening for abdominal aortic aneurysms (AAAs) measuring 3 cm or greater decreases AAA-related mortality rates in men aged 65 years or older.

PURPOSE: To systematically review evidence about the benefits and harms of ultrasonography screening for AAAs in asymptomatic primary care patients.

DATA SOURCES: MEDLINE, the Database of Abstracts of Reviews of Effects, the Cochrane Central Register of Controlled Trials (January 2004 through January 2013), clinical trial registries, reference lists, experts, and a targeted bridge search for population-based screening RCTs through September 2013.

STUDY SELECTION: English-language, population-based, fair- to good-quality RCTs and large cohort studies for AAA screening benefits as well as RCTs and cohort and registry studies for harms in adults with AAA.

DATA EXTRACTION: Dual quality assessment and abstraction of study details and results.

DATA SYNTHESIS: Reviews of 4 RCTs involving 137,214 participants demonstrated that 1-time invitation for AAA screening in men aged 65 years or older reduced AAA rupture and AAA-related mortality rates for up to 10 and 15 years, respectively, but had no statistically significant effect on all-cause mortality rates up to 15 years. Screening was associated with more overall and elective surgeries but fewer emergency operations and lower 30-day operative mortality rates at up to 10- to 15-year follow-up. One RCT involving 9342 women showed that screening had no benefit on AAA-related or all-cause mortality rates.

LIMITATIONS: Trials included mostly white men outside of the United States. Information for subgroups and about rescreening was limited.

CONCLUSION: One-time invitation for AAA screening in men aged 65 years or older was associated with decreased AAA rupture and AAA-related mortality rates but had little or no effect on all-cause mortality rates.

PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.


Clinical Comments

Public Health

This is useful information: preventive efforts should be directed to more effective activities.

Surgery - Vascular

This is an important Review. Nevertheless, it includes papers related to old epidemiological data. Recently, UK screening program for AAA identified a low prevalence of that vascular disorder probably due to improved and healthy behavior (less smoking, statin use,...). It could be beneficial to increase the age threshold up to 70 y.

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