The Gloucestershire Aneurysm Screening Programme: the first 2 years' experience

Screening for abdominal aortic aneurysm: a single scan is enough

A group of 223 men who were found to have a normal abdominal aortic diameter (less than 2.6 cm) at the age of 65 or 66 years when first examined by ultrasonography in 1988 was studied again 5 years later. Twenty-seven patients had died, none from confirmed aneurysm rupture, and repeat scans were obtained in 189 of the 196 survivors. A further patient was reassessed at laparotomy. Mean aortic diameter was unchanged during the intervening 5 years and 166 of 189 repeat scan measurements were within 3 mm of the original value. Only two patients were found to have an aortic diameter of 3 cm or more on rescanning. These results suggest that a single ultrasonographic examination at the age of 65 years can safely be used to exclude over 90 per cent of those examined from future risk of significant aneurysmal dilatation of the aorta, with important cost and organizational benefits for a population screening programme.

Endovascular repair of abdominal aortic aneurysm: limitations of the single proximal stent technique

Endovascular repair of abdominal aortic aneurysm (AAA) has been performed using both a single proximal stent technique and a double (proximal and distal) stent method to anchor a graft in the aneurysm lumen. This study examined the effect of the single proximal stent technique on femoral artery blood flow, renal function and the occurrence of back-bleeding into the aneurysm sac in a canine model; eight dogs were used. Femoral artery blood flow and glomerular filtration rate were not affected by graft-stent insertion. Two graft-stent combinations failed to deploy in the correct position and led to graft thrombosis in one case. The six correctly positioned grafts all showed back-bleeding from around the distal end into the aneurysm sac. The single proximal stent technique for endovascular repair of AAA is inadequate and attention should continue to focus on a double (proximal and distal) stent method or a bifurcated system.

Little impact of elective surgery on the incidence and mortality of ruptured aortic aneurysms

Rupture of an abdominal aortic aneurysm is an important cause of death, particularly for men over 60 years of age. The aim of elective surgery for abdominal aortic aneurysms is to prevent future death from rupture of the aneurysm. The present study examines the influence of elective surgery upon the rate of rupture, comparing 1980 when little elective surgery was done and 1989 when considerably more elective surgery was performed in a well defined population. The rate of rupture and death from such a cause was not affected by the increased number of elective operations. It is concluded that the number of operations generally performed is too small to significantly affect the mortality from rupture. In order to decrease this mortality patients with a high risk of rupture should be found and offered elective surgery.

An abdominal aortic aneurysm screening programme for all males over the age of 50 years

Previously published ultrasound screening programmes for abdominal aortic aneurysm (AAA) have concentrated on males in the 65 to 75 year age range, suggesting this as the most cost-effective cohort to target. In this unique study we have broadened the criteria for screening. General practitioners in one health district were approached to supply details of all males aged 50 years and over to be offered aortic ultrasound scanning. Over a period of 18 months, 4145 individuals were asked to attend and 3030 (73%) have attended. Attendance rates were: between 50 and 64 years, 73%; between 65 and 79 years, 75%; for 80 years and over, 64%--significantly less (p = 0.01-0.001) than the other two age bands. Aortic dilatation (diameter > or = 2.5 cm) was found in 6.3% of the 50 to 64 year age group, 16.8% of the 65 to 79 year age group, and 23.3% of the 80 years and over age group. An established aneurysm (> or = 4.6 cm) was found in 0.3%--6 individuals (50-64 years), 2.5% (65-79 years) and 4.1% (> or = 80 years). The results suggest that aortic screening may be worthwhile extending to a wider age band. By focusing follow-up, this should give greater value for younger men in terms of community productivity and allows for selective intervention in the elderly.

Familial abdominal aortic aneurysm: prevalence and implications for screening

The high prevalence of abdominal aortic aneurysm (AAA) in men over the age of 65 has led to the establishment of ultrasound screening programmes for this group. The apparent familial tendency towards AAA formation suggests that relatives of aneurysm patients may form another subpopulation in whom screening is appropriate. The first degree relatives of 100 consecutive aneurysm patients were identified. Of 110 relatives over 50 years of age, two were known to have had AAA and ultrasound scans were performed on 74, providing information on aortic size for 76 relatives (69%). No further aortic aneurysms (antero-posterior diameter > or = 4.0 cm) were found on scanning. However, nine relatives were demonstrated to have aortic dilatation (2.5-3.9 cm). Aortic dilatation was observed in 21% of male first degree relatives over 50 years of age, affecting 27% of sons and 17% of brothers. Only 4% of the sisters and none of the daughters were found to have aortic dilatation. The prevalence of aortic enlargement seems to be sufficiently high amongst male first degree relatives of AAA patients over 50 years of age to justify aortic screening.