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Pumares-García L, Paredes-Mariñas E, Calsina-Juscafresa L, Subirana-Cachinero I, Miralles-Hernández M, Clarà-Velasco A. Association of polypharmacy scores with the long-term survival of patients with intact aortoiliac aneurysms and indication for repair. J Vasc Surg 2024; 79:540-546.e2. [PMID: 37923020 DOI: 10.1016/j.jvs.2023.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE/BACKGROUND Our study analyzed the relationship between two polypharmacy scores (addition of chronic prescribed drugs [ACPDs] and Rx-Risk Comorbidity Index) and survival in patients with an intact abdominal aortic and/or common iliac aneurysm (AAA). METHODS Consecutive retrospective, single-center cohort of patients attended for an intact AAA with indication for repair from 2008 to 2021. Demographic data, Charlson Comorbidity Index, AAA treatment, ACPD, and Rx-Risk polypharmacy scores were recorded at baseline. Main outcomes were the 5-year and long-term survival rates. The statistical analysis included Cox regression, area under the curve, and continuous net reclassification index. RESULTS A total of 424 patients with AAA were evaluated (median age: 76 years; 92.2% male, median Charlson index 2), of whom 314 (74.1%) underwent intervention (80% endovascular and 20% open) and 110 (25.9%) did not. During follow-up (mean 4.6 years), 245 patients (57.8%) died, with 1-month, 1-year, and 5-year survival rates of 98.1%, 86.3%, and 52.7%, respectively. ACPD and Rx-Risk indices (median [interquartile range]: 6 [4-9] and 3 [0-5], respectively) were significantly and linearly associated (P < .001) with survival, with the best cutoff points at 5 and 0, respectively. An ACPD >5 (patients with >5 chronically prescribed drugs at baseline) and an Rx-Risk >0 were associated with a 45.2% (P = .038) and 102% (P = .002) increase in 5-year mortality, respectively, after adjustment for age, sex, Charlson index, and type of AAA treatment. Both polypharmacy indices improved significantly the discriminative power of the Charlson Comorbidity Index in predicting survival. CONCLUSIONS Both ACPD and Rx-Risk polypharmacy scores are independently related to survival among patients with an intact AAA and indication for repair. Their behavior is similar, so the simple ACPD >5 appears to be sufficient to identify patients with lower survival rates.
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Affiliation(s)
| | - Ezequiel Paredes-Mariñas
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Barcelona, Spain; Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Calsina-Juscafresa
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Barcelona, Spain; Department of Medicine and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Isaac Subirana-Cachinero
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Cardiovascular, IMIM-Parc de Salut Mar, Barcelona, Spain
| | | | - Albert Clarà-Velasco
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Barcelona, Spain; Department of Medicine and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER Cardiovascular, IMIM-Parc de Salut Mar, Barcelona, Spain.
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Mansoor SM, Rabben T, Hisdal J, Jørgensen JJ. Eleven-Year Outcomes of a Screening Project for Abdominal Aortic Aneurysm (AAA) in 65-Year-Old Men. Vasc Health Risk Manag 2023; 19:459-467. [PMID: 37485231 PMCID: PMC10361273 DOI: 10.2147/vhrm.s412954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Since 2011, the Department of Vascular Surgery at Oslo University Hospital has offered screening for abdominal aortic aneurysm (AAA) to 65-year-old men living in Oslo, Norway. The aim of this study was to evaluate the effect of the screening project on AAA-related mortality and rupture and repair rates in the screened population. Methods This cohort study included men that participated in AAA screening at the Department of Vascular Surgery at Oslo University Hospital in the period May 2011 to September 2019. All men with screen-detected AAA (aortic diameter ≥30 mm) and subaneurysmal aortic dilatation (aortic diameter 25-29 mm) were included. A stratified (1:1 with the subaneurysm group), randomized selection of men with normal aortic diameter (<25 mm) upon screening was also included. The follow-up data on events (ruptures, repairs, and deaths) after screening were collected retrospectively from patient electronic medical records at Oslo University Hospital, the National Population Register and the Norwegian Cause of Death Registry (CoDR). Results In total, 2048 men were included, with a median follow-up time of 7.1 years (IQR 3.8). Among men with screen-detected AAA, 0.6% died of AAA-related causes (0.9 AAA-related deaths per 1000 person-years). The rupture rate was 0.3% among men with screen-detected AAA or subaneurysmal aortic dilatation, giving an incidence of 0.5 ruptures per 1000 person-years. The overall repair rate in the AAA group was 20.6% (36.1 repairs per 1000 person-years) and 0.6% (0.9 repairs per 1000 person-years) in the subaneurysm group. Conclusion In a population screened for AAA, the incidence of rupture and the AAA-related mortality was very low. Almost one-fifth of the participants with screen-detected AAA underwent elective repair, representing a group that might have presented with rupture if untreated. These results indicate that screening is valuable in preventing AAA rupture and AAA-related mortality.
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Affiliation(s)
- Saira Mauland Mansoor
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Toril Rabben
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Jonny Hisdal
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jørgen Joakim Jørgensen
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Traumatology, Oslo University Hospital, Oslo, Norway
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Kim H, Kwon TW, Cho YP, Gwon JG, Han Y, Lee SA, Kim YJ, Kim S. An Epidemiologic Study of the Incidence and Mortality of Abdominal Aortic Aneurysms in Koreans Aged ≥50 Years from 2009 to 2018 Based on a National Database. J Clin Med 2023; 12:4319. [PMID: 37445354 DOI: 10.3390/jcm12134319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/18/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Large-scale population studies of the incidence of and mortality from abdominal aortic aneurysm (AAA) are needed to develop healthcare policies and priorities. The aim of this study was to estimate the incidence of AAA and the all-cause mortality from it among Koreans aged ≥50 years from 2009 to 2018 using data from the Korean National Health Insurance System Database. The crude and standardized incidence and all-cause mortality of the disease among patients with unruptured AAA were calculated. A total of 73,933 AAA patients were identified. The overall incidence of AAA in adults ≥50 years during the study period was 37.5 per 100,000 population (49.7 per 100,000 in men and 26.8 per 100,000 in women), with an increase from 32.33 per 100,000 persons in 2009 to 46.85 per 100,000 in 2018. The crude all-cause mortality rate of patients with untreated AAA was 21.26/100 person-years in 2009 and 8.87/100 person-years in 2018, with decreasing trends observed both in men and women. This nationwide study showed that the incidence of AAA in Koreans aged ≥50 years in 2018 was 63.40 per 100,000 in men and 32.07 per 100,000 in women. The overall rates were 0.06% and 0.03%, respectively, with an increasing trend. Mortality has decreased in both treated and untreated patients. The observed increase in incidence suggests a rising burden of AAA in the Korean population, particularly among men. The decreasing mortality rates may indicate improvements in the management and treatment of AAA over the study period.
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Affiliation(s)
- Hyangkyoung Kim
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea
| | - Tae-Won Kwon
- Division of Vascular Surgery, Department of Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul 05505, Republic of Korea
- Department of Acute Care Surgery, Korea University Guro Hospital, Seoul 08308, Republic of Korea
- Armed Forces Trauma Center, Seongnam 13574, Republic of Korea
| | - Yong-Pil Cho
- Division of Vascular Surgery, Department of Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Jun Gyo Gwon
- Division of Vascular Surgery, Department of Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Youngjin Han
- Division of Vascular Surgery, Department of Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Sang Ah Lee
- Division of Vascular Surgery, Department of Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, College of Medicine, University of Ulsan, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Seonok Kim
- Department of Clinical Epidemiology and Biostatistics, College of Medicine, University of Ulsan, Asan Medical Center, Seoul 05505, Republic of Korea
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Li SR, Reitz KM, Kennedy J, Gabriel L, Phillips AR, Shireman PK, Eslami MH, Tzeng E. Epidemiology of age-, sex-, and race-specific hospitalizations for abdominal aortic aneurysms highlights gaps in current screening recommendations. J Vasc Surg 2022; 76:1216-1226.e4. [PMID: 35278654 PMCID: PMC9458770 DOI: 10.1016/j.jvs.2022.02.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/24/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND The detection and elective repair of abdominal aortic aneurysms (AAA) guided by known risk-factor specific screening decrease AAA-related mortality. However, minimal epidemiologic data exist for AAA in female persons and racial minority groups. We established the contemporary risk of US AAA hospitalization across age, sex, and race. METHODS National Inpatient Sample and US Census (2012-2018) data were used to quantify age-, sex-, and race-specific incidences and adjusted odds ratios (aOR) of AAA hospitalizations (≥18 years), associated risk factors, and in-hospital mortality. Interaction terms evaluated subgroups. RESULTS Among 1,728,374,183 US residents during the study period (51.3% female; 78.4% White, 12.7% Black, 5.7% Asian), 211,501,703 were hospitalized (aged 57.56 ± 0.04 years; 58.4% female; 64.9% White, 14.3% Black, 2.5% Asian) of which 291,850 were for AAA (aged 73.17 ± 0.04 years; 22.6% female; 81.8% White, 5.6% Black, 1.6% Asian). An estimated 15.2 (95% CI, 15.1-15.3) and 1.7 (95% CI, 1.7-1.7) hospitalizations per 100,000 residents were for intact AAA (iAAA) and ruptured AAA (rAAA) AAA, respectively. In addition, 16.2% of iAAA (83.8% male; 79.1% White) and 18.4% of rAAA (86.4% male; 75.0% White) hospitalizations occurred in patients less than 65 years of age. For iAAA, female sex (aOR, 0.27; 95% CI, 0.27-0.28) compared with male sex and both Black (0.47; 95% CI, 0.45-0.49) and Asian (0.86; 95% CI, 0.83-0.93) persons compared with White persons had a reduced aOR for hospitalization. For rAAA, the reduced aOR persisted for female sex (0.33; 95% CI, 0.32-0.36) and for Black persons (0.52; 95% CI, 0.46-0.58). Although female sex demonstrated an overall decreased odds of AAA hospitalization, female persons who were older, Black, or had peripheral vascular disease (Pinteractions < .001) had a relative increase in AAA hospitalization aOR. Female sex (aOR, 1.54; 95% CI, 1.38-1.70), but not Black or Asian race, was associated with increased mortality which was more pronounced for iAAA (1.93; 95% CI, 1.66-2.25) than rAAA (1.29; 95% CI, 1.13-1.48]; Pinteraction < .001). CONCLUSIONS We confirmed a substantially decreased adjusted risk of AAA hospitalization for females and racial minority groups; however, aging and comorbid peripheral vascular disease decreased these differences. The disparate risk of AAA hospitalization by sex and race highlights the importance of inclusivity in future AAA studies.
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Affiliation(s)
- Shimena R Li
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Katherine M Reitz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
| | - Jason Kennedy
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA; Department of Critical Care and Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Lucine Gabriel
- School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Amanda R Phillips
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Paula K Shireman
- Department of Surgery, University of Texas Health San Antonio, San Antonio, TX; South Texas Veterans Health Care System, San Antonio, TX; University Health, San Antonio, TX
| | - Mohammad H Eslami
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Edith Tzeng
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
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Meecham L, Jacomelli J, Davis M, Pherwani A, Lees T, Earnshaw JJ. Outcomes in Men From the NHS Abdominal Aortic Aneurysm Screening Programme With a Large Aneurysm Referred for Intervention. Eur J Vasc Endovasc Surg 2020; 61:192-199. [PMID: 33594980 DOI: 10.1016/j.ejvs.2020.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/24/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP) has been implemented since 2013. Men with a large aneurysm >54 mm, either at first screen or during surveillance, are referred for intervention. The aim of the present study was to explore outcomes in these men and to see whether there was any regional variation in treatment rates and type of repair. METHODS The study cohort included all men referred to a vascular network with a large abdominal aortic aneurysm (AAA). Basic demographic information, nurse assessment details, as well as outcome data were extracted from the national NAAASP IT system, AAA SMaRT, for analysis. RESULTS Some 3 026 men were referred for possible intervention (48% first screen, 52% surveillance). Some 448 men (13.3%) either declined (63, 2.1%), or were turned down for early intervention for various reasons (385, 12.7%). Some 8% were declined for medical reasons (true turn down rate). Men referred from surveillance were older, and more likely not to have had elective surgery within three months (16.0 vs. 11.2%; HR 1.37, 95% CI 1.07-1.75, p = .011). Turn down rates did not vary among local programmes, when surveillance men were taken into account. Some 2 624 (87%) men had planned AAA repair, with a peri-operative mortality of 1.3%. Thirty day surgical mortality was lower after EVAR: 0.4% compared with 2.1% after open repair. The method of repair remained consistent year on year, with roughly equal numbers undergoing endovascular (50%) and open surgical repair (48%); 2% unknown. There was regional variation in the proportion treated by endovascular repair: from 20% to 97%. CONCLUSION The turn down rate after referral for treatment with a screen detected AAA was low, but there remains considerable regional variation in the proportion undergoing endovascular repair. Procedures were undertaken with low peri-operative mortality.
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Affiliation(s)
- Lewis Meecham
- University Department of Vascular Surgery, Heart of England NHS Foundation Trust, UK
| | - Jo Jacomelli
- NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP), Public Health England, UK
| | | | | | - Tim Lees
- NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP), Public Health England, UK
| | - Jonothan J Earnshaw
- NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP), Public Health England, UK.
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6
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Ecografía clínica en el riesgo cardiovascular. Rev Clin Esp 2020; 220:364-373. [DOI: 10.1016/j.rce.2019.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 11/09/2019] [Indexed: 11/16/2022]
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7
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Beltrán L, Rodilla E. Clinical ultrasonography in cardiovascular risk. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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8
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Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, Dick F, van Herwaarden J, Karkos C, Koelemay M, Kölbel T, Loftus I, Mani K, Melissano G, Powell J, Szeberin Z, ESVS Guidelines Committee, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Kolh P, Lindholt JS, de Vega M, Vermassen F, Document reviewers, Björck M, Cheng S, Dalman R, Davidovic L, Donas K, Earnshaw J, Eckstein HH, Golledge J, Haulon S, Mastracci T, Naylor R, Ricco JB, Verhagen H. Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2019; 57:8-93. [DOI: 10.1016/j.ejvs.2018.09.020] [Citation(s) in RCA: 873] [Impact Index Per Article: 174.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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9
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Linné A, Forsberg J, Leander K, Hultgren R. Screening of siblings to patients with abdominal aortic aneurysms in Sweden. SCAND CARDIOVASC J 2017; 51:167-171. [PMID: 28325098 DOI: 10.1080/14017431.2017.1303189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The prevalence of Abdominal Aortic Aneurysm (AAA) is higher for First Degree Relatives to AAA-patients compared to the general population, regardless of sex. The prevalence of AAA is also higher in the North of Sweden compared to the Mid and South. A regional strong hereditary trait has been suggested as an explanation to this. The aim of this study was to investigate if siblings to AAA-patients in the North have a higher prevalence of AAA compared to siblings in the Mid-region. DESIGN Cohort study. MATERIALS AND METHODS All patients treated for AAA in a northern region (Norrbotten county, North) were screened for siblings. Consenting siblings, age 40-80, were examined (n = 379) with ultrasound. The results were compared to the previously published results of 150 ultrasound-screened siblings in the Mid-region (Stockholm county). RESULTS The male/female ratio in the sibling cohort was 48% vs 52%. The prevalence of AAA in siblings in the North was 37/379 (brothers 14%, sisters 6%). This was not different from the prevalence among the Mid-region siblings 16/150 (brothers 17%, sisters 6% (p = 0.75). The distribution of risk factors was similar in the two regions. CONCLUSION The results reinforce the importance of a more systematic approach towards selective screening of all siblings to AAA patients. Ultrasound should be performed in all eligible siblings, since the distribution of AAA is similar over regions. A correlation between the familial distribution and the reported high prevalence of AAA in general population in the North could not be shown.
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Affiliation(s)
- Anneli Linné
- a Section of Vascular Surgery, Department of Surgery, Department of Clinical Science and Education , Karolinska Institutet at Södersjukhuset , Stockholm , Sweden
| | - Johan Forsberg
- b Department of Molecular Medicine and Surgery , Karolinska Institutet , Luleå , Stockholm.,c Department of Surgery , Sunderby Hospital , Luleå , Sweden
| | - Karin Leander
- d Institute of Environmental Medicine, Unit of Cardiovascular Epidemiology , Karolinska Institutet , Stockholm , Sweden
| | - Rebecka Hultgren
- b Department of Molecular Medicine and Surgery , Karolinska Institutet , Luleå , Stockholm.,e Department of Vascular Surgery , Karolinska University Hospital , Stockholm , Sweden
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Powell JT. Diverse Requirements for Efficient Population Screening for Abdominal Aortic Aneurysm: From Program Management to Maintaining Skills in Open Repair. Circulation 2016; 134:1149-1151. [PMID: 27754947 DOI: 10.1161/circulationaha.116.024916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Janet T Powell
- From Imperial College London, Vascular Surgery Research Group, Charing Cross Hospital, London, United Kingdom.
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11
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Lindholt JS. Commentary on 'Gender related Outcome Inequalities in Endovascular Aneurysm Repair'. Please still take good care of the ladies. Eur J Vasc Endovasc Surg 2016; 52:526. [PMID: 27595523 DOI: 10.1016/j.ejvs.2016.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- J S Lindholt
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Odense, Elitary Research Centre of Individualised Medicine in Arterial Disease, Cardiovascular Centre of Excellence in the Southern Region of Denmark, Odense, Denmark.
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12
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Jacomelli J, Summers L, Stevenson A, Lees T, Earnshaw JJ. Impact of the first 5 years of a national abdominal aortic aneurysm screening programme. Br J Surg 2016; 103:1125-31. [DOI: 10.1002/bjs.10173] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/06/2015] [Accepted: 02/18/2016] [Indexed: 11/07/2022]
Abstract
Abstract
Background
The Abdominal Aortic Aneurysm (AAA) Screening Programme was introduced by the National Health Service (NHS) in England to reduce the rate of death from ruptured AAA in men. The programme commenced in 2009 and was implemented completely across the country in April 2013. The aim was to review the first 5 years of the programme, looking specifically at compliance and early outcome.
Methods
Men aged 65 years were invited for a single abdominal ultrasound scan. Data were entered into a bespoke database (AAA SMaRT). This was a planned analysis after the first 5 years of the programme.
Results
The summation analysis involved the first 700 000 men screened, and the first 1000 men with a large AAA referred for possible treatment. The prevalence of AAA (aortic diameter larger than 2·9 cm) in 65-year-old men was 1·34 per cent. Mean uptake was 78·1 per cent, but varied from 61·7 to 85·8 per cent across the country. Based on the Index of Multiple Deprivation, uptake was 65·1 per cent in the most deprived versus 84·1 per cent in the least deprived areas. Of the first 1000 men referred for possible treatment of a large AAA (greater than 5·4 cm), the false-positive rate was 3·2 per cent. Some 870 men underwent a planned AAA intervention (non-intervention rate 9·2 per cent), with seven deaths (perioperative mortality rate 0·8 per cent).
Conclusion
The processes in the NHS AAA Screening Programme are effective in detecting and treating men with AAA.
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Affiliation(s)
| | | | | | - T Lees
- Department of Vascular Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J J Earnshaw
- Department of Vascular Surgery, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
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13
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Linné A, Forsberg J, Lindström D, Ideskog E, Hultgren R. Age at detection of abdominal aortic aneurysms in siblings of patients with abdominal aortic aneurysms. J Vasc Surg 2016; 63:883-7. [DOI: 10.1016/j.jvs.2015.10.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/07/2015] [Indexed: 11/26/2022]
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Grant SW, Sperrin M, Carlson E, Chinai N, Ntais D, Hamilton M, Dunn G, Buchan I, Davies L, McCollum CN. Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation. Health Technol Assess 2016; 19:1-154, v-vi. [PMID: 25924187 DOI: 10.3310/hta19320] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) repair aims to prevent premature death from AAA rupture. Elective repair is currently recommended when AAA diameter reaches 5.5 cm (men) and 5.0 cm (women). Applying population-based indications may not be appropriate for individual patient decisions, as the optimal indication is likely to differ between patients based on age and comorbidities. OBJECTIVE To develop an Aneurysm Repair Decision Aid (ARDA) to indicate when elective AAA repair optimises survival for individual patients and to assess the cost-effectiveness and associated uncertainty of elective repair at the aneurysm diameter recommended by the ARDA compared with current practice. DATA SOURCES The UK Vascular Governance North West and National Vascular Database provided individual patient data to develop predictive models for perioperative mortality and survival. Data from published literature were used to model AAA growth and risk of rupture. The cost-effectiveness analysis used data from published literature and from local and national databases. METHODS A combination of systematic review methods and clinical registries were used to provide data to populate models and inform the structure of the ARDA. Discrete event simulation (DES) was used to model the patient journey from diagnosis to death and synthesised data were used to estimate patient outcomes and costs for elective repair at alternative aneurysm diameters. Eight patient clinical scenarios (vignettes) were used as exemplars. The DES structure was validated by clinical and statistical experts. The economic evaluation estimated costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) from the NHS, social care provider and patient perspective over a lifetime horizon. Cost-effectiveness acceptability analyses and probabilistic sensitivity analyses explored uncertainty in the data and the value for money of ARDA-based decisions. The ARDA outcome measures include perioperative mortality risk, annual risk of rupture, 1-, 5- and 10-year survival, postoperative long-term survival, median life expectancy and predicted time to current threshold for aneurysm repair. The primary economic measure was the ICER using the QALY as the measure of health benefit. RESULTS The analysis demonstrated it is feasible to build and run a complex clinical decision aid using DES. The model results support current guidelines for most vignettes but suggest that earlier repair may be effective in younger, fitter patients and ongoing surveillance may be effective in elderly patients with comorbidities. The model adds information to support decisions for patients with aneurysms outside current indications. The economic evaluation suggests that using the ARDA compared with current guidelines could be cost-effective but there is a high level of uncertainty. LIMITATIONS Lack of high-quality long-term data to populate all sections of the model meant that there is high uncertainty about the long-term clinical and economic consequences of repair. Modelling assumptions were necessary and the developed survival models require external validation. CONCLUSIONS The ARDA provides detailed information on the potential consequences of AAA repair or a decision not to repair that may be helpful to vascular surgeons and their patients in reaching informed decisions. Further research is required to reduce uncertainty about key data, including reintervention following AAA repair, and assess the acceptability and feasibility of the ARDA for use in routine clinical practice. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Stuart W Grant
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Matthew Sperrin
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Eric Carlson
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Natasha Chinai
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Dionysios Ntais
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Matthew Hamilton
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Graham Dunn
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Iain Buchan
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Linda Davies
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Charles N McCollum
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
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15
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Outcome in Men with a Screen-detected Abdominal Aortic Aneurysm Who are not Fit for Intervention. Eur J Vasc Endovasc Surg 2015; 50:732-6. [DOI: 10.1016/j.ejvs.2015.07.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/22/2015] [Indexed: 11/18/2022]
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16
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Saquib N, Saquib J, Ioannidis JP. Does screening for disease save lives in asymptomatic adults? Systematic review of meta-analyses and randomized trials. Int J Epidemiol 2015; 44:264-77. [DOI: 10.1093/ije/dyu140] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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17
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Choke E. Commentary on 'Low post-operative mortality after surgery on patients with screening-detected abdominal aortic aneurysms: a Swedvasc registry study'. Eur J Vasc Endovasc Surg 2014; 48:657-8. [PMID: 25465471 DOI: 10.1016/j.ejvs.2014.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 10/26/2014] [Indexed: 11/25/2022]
Affiliation(s)
- E Choke
- Leicester Royal Infirmary, Leicester, UK.
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18
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Svensjö S, Björck M, Wanhainen A. Update on Screening for Abdominal Aortic Aneurysm: A Topical Review. Eur J Vasc Endovasc Surg 2014; 48:659-67. [DOI: 10.1016/j.ejvs.2014.08.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/31/2014] [Indexed: 11/30/2022]
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19
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Linné A, Smidfelt K, Langenskiöld M, Hultgren R, Nordanstig J, Kragsterman B, Lindström D. Low Post-operative Mortality after Surgery on Patients with Screening-detected Abdominal Aortic Aneurysms: A Swedvasc Registry Study. Eur J Vasc Endovasc Surg 2014; 48:649-56. [DOI: 10.1016/j.ejvs.2014.08.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/24/2014] [Indexed: 11/26/2022]
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20
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Rudarakanchana N, Jenkins M. Management of abdominal aortic aneurysms in the UK. Br J Hosp Med (Lond) 2014; 75:578-83. [PMID: 25291611 DOI: 10.12968/hmed.2014.75.10.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Outcomes of abdominal aortic aneurysm repair are improving in the UK, at least in part as a result of vascular specialization, the reconfiguration of services to dedicated vascular centres and the advent of the national screening programme.
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Affiliation(s)
- Nung Rudarakanchana
- Specialist Registrar and Clinical Lecturer in Vascular Surgery in the Department of Biosurgery and Surgical Technology
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21
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Earnshaw J. The National Health Service Abdominal Aortic Aneurysm Screening Programme in England. GEFASSCHIRURGIE 2014. [DOI: 10.1007/s00772-014-1331-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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22
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De Rango P. Current gaps in diagnosis and management of ruptured abdominal aortic aneurysms: best fusion imaging technology may not replace confusion in physician decision-making. J Endovasc Ther 2014; 21:576-8. [PMID: 25101589 DOI: 10.1583/13-4626c.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Paola De Rango
- Unit of Vascular and Endovascular Surgery, Hospital S. Maria Misericordia, Perugia, Italy
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23
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Evaluation of the accuracy of aorta scan BVI 9600 in screening for abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2014; 48:147-52. [PMID: 24882423 DOI: 10.1016/j.ejvs.2014.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 04/24/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Despite a decreasing incidence of abdominal aortic aneurysm (AAA), the cost-effectiveness of AAA ultrasound screening can be improved by reducing the screening costs and increasing the uptake rates. The BVI 9600 (BVI) is a promising tool for this purpose as it is inexpensive and can detect AAA without a trained operator. This study aims to investigate whether the BVI can be used to detect AAA for the purpose of a low-cost outreach screening approach. METHODS A total of 142 subjects had their abdominal aortae measured by five sonographers using the BVI and a conventional ultrasound machine. The examination included four anterior-posterior measurements at four equally spaced scanning locations from the xiphisternum to the umbilicus. The measurements produced by each machine were compared using Bland-Altman plots, followed by an analysis of the AAA detection performance. RESULTS The BVI measured the aortic diameter to within 0.88-1.56 cm of the true diameter, exceeding the 0.5 cm "clinically acceptable difference" (CAD). Its accuracy was poorer when measuring the aneurysmal aortae (mean difference -0.56 cm, variability 1.72 cm) than normal aortae (mean difference 0.02 cm, variability 0.76 cm). Nine out of 52 aneurysms were not detected due to undersizing measurement and non-visualization of the aortae. CONCLUSIONS At present, the BVI is not sufficiently accurate to detect AAA for screening purposes. A number of technical features require improvement.
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Mell MW, Baker LC, Dalman RL, Hlatky MA. Gaps in preoperative surveillance and rupture of abdominal aortic aneurysms among Medicare beneficiaries. J Vasc Surg 2014; 59:583-8. [DOI: 10.1016/j.jvs.2013.09.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 11/28/2022]
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Jawien A, Formankiewicz B, Derezinski T, Migdalski A, Brazis P, Woda L. Abdominal aortic aneurysm screening program in Poland. GEFASSCHIRURGIE : ZEITSCHRIFT FUR VASKULARE UND ENDOVASKULARE CHIRURGIE : ORGAN DER DEUTSCHEN UND DER OSTERREICHISCHEN GESELLSCHAFT FUR GEFASSCHIRURGIE UNTER MITARBEIT DER SCHWEIZERISCHEN GESELLSCHAFT FUR GEFASSCHIRURGIE 2014; 19:545-548. [PMID: 26120253 PMCID: PMC4479383 DOI: 10.1007/s00772-014-1348-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Screening for abdominal aortic aneurysms (AAA) is currently recommended by several vascular societies. In countries where it has been introduced the prevalence of AAAs differed greatly and was mainly related to cigarette smoking. The screening program also had an enormous impact on the decrease of AAA ruptures and reduced mortality rate. These facts have led to the introduction of the first screening program for AAAs in Poland. OBJECTIVE The aim of the study was to determine the prevalence of AAAs among men aged 60 years and older undergoing ultrasound examination of the abdominal aorta. MATERIAL AND METHODS A single ultrasonography of the abdomen was performed to assess the aorta from the renal arteries to the bifurcation and the diameter of the aorta was measured at its widest point. The cut-off value for determining an aortic aneurysm was set at a diameter of ≥ 30 mm. All ultrasonography measurements were performed by physicians in outpatient departments throughout the Kuyavian-Pomeranian Province. Additionally, each subject had to fill out a questionnaire with demographic data, smoking habits, existing comorbidities and familial occurrence of AAAs. The study was conducted from October 2009 to November 2011. RESULTS The abdominal aorta ultrasound examinations were carried out in 1556 men aged 60 years and older. The prevalence of AAA in the study population was 6.0 % (94 out of 1556). The average age of the men was 69 years (SD 6 years, range 60-92 years). In the study population 55 % of the men smoked or had smoked and 3 % were aware of the presence of AAAs in family members. There were three risk factors significantly associated with the presence of AAAs: age (p < 0.05), smoking (72.3 % vs 53.9 %, p = 0.004) and family history of AAAs (9.6 % vs 2.7 %, p = 0.017). CONCLUSION The prevalence of AAAs among men in Poland is higher than in other European countries and the USA. The screening program for AAAs is an easy and reliable method for detecting early stages of the disease and risk factors which are the driving forces for the development of AAAs.
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Affiliation(s)
- A. Jawien
- Department of Vascular Surgery and Angiology, University Hospital No.1, Collegium Medicum, University of Nicolai Copernicus, M.Sklodowskiej-Curie Street 9, 85-094 Bydgoszcz, Poland
| | - B. Formankiewicz
- Department of Vascular Surgery and Angiology, University Hospital No.1, Collegium Medicum, University of Nicolai Copernicus, M.Sklodowskiej-Curie Street 9, 85-094 Bydgoszcz, Poland
| | - T. Derezinski
- Department of Vascular Surgery and Angiology, University Hospital No.1, Collegium Medicum, University of Nicolai Copernicus, M.Sklodowskiej-Curie Street 9, 85-094 Bydgoszcz, Poland
| | - A. Migdalski
- Department of Vascular Surgery and Angiology, University Hospital No.1, Collegium Medicum, University of Nicolai Copernicus, M.Sklodowskiej-Curie Street 9, 85-094 Bydgoszcz, Poland
| | - P. Brazis
- Department of Vascular Surgery and Angiology, University Hospital No.1, Collegium Medicum, University of Nicolai Copernicus, M.Sklodowskiej-Curie Street 9, 85-094 Bydgoszcz, Poland
| | - L. Woda
- Department of Vascular Surgery and Angiology, University Hospital No.1, Collegium Medicum, University of Nicolai Copernicus, M.Sklodowskiej-Curie Street 9, 85-094 Bydgoszcz, Poland
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26
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Mell MW, Hlatky MA, Shreibati JB, Dalman RL, Baker LC. Late diagnosis of abdominal aortic aneurysms substantiates underutilization of abdominal aortic aneurysm screening for Medicare beneficiaries. J Vasc Surg 2013; 57:1519-23, 1523.e1. [DOI: 10.1016/j.jvs.2012.12.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 10/24/2012] [Accepted: 12/09/2012] [Indexed: 10/27/2022]
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27
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Davis M, Harris M, Earnshaw JJ. Implementation of the National Health Service Abdominal Aortic Aneurysm Screening Program in England. J Vasc Surg 2013; 57:1440-5. [DOI: 10.1016/j.jvs.2012.10.114] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 10/23/2012] [Accepted: 10/25/2012] [Indexed: 01/16/2023]
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Lohoefer F, Reeps C, Lipp C, Rudelius M, Zimmermann A, Ockert S, Eckstein HH, Pelisek J. Histopathological analysis of cellular localization of cathepsins in abdominal aortic aneurysm wall. Int J Exp Pathol 2012; 93:252-8. [PMID: 22804761 DOI: 10.1111/j.1365-2613.2012.00819.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
An important feature of abdominal aortic aneurysm (AAA) is the destruction of vessel wall, especially elastin and collagen. Besides matrix metalloproteinases, cathepsins are the most potent elastolytic enzymes. The expression of cathepsins with known elastolytic and collagenolytic activities in the individual cells within AAA has not yet been determined. The vessel wall of 32 AAA patients and 10 organ donors was analysed by immunohistochemistry for expression of cathepsins B, D, K, L and S, and cystatin C in all cells localized within AAA. Luminal endothelial cells (ECs) of AAA were positive for cathepsin D and partially for cathepsins B, K and S. Endothelial cells of the neovessels and smooth muscle cells in the media were positive for all cathepsins tested, especially for cathepsin B. In the inflammatory infiltrate all cathepsins were expressed in the following pattern: B > D = S > K = L. Macrophages showed the highest staining intensity for all cathepsins. Furthermore, weak overall expression of cystatin C was observed in all the cells localized in the AAA with the exception of the ECs. There is markedly increased expression of the various cathepsins within the AAA wall compared to healthy aorta. Our data are broadly consistent with a role for cathepsins in AAA; and demonstrate expression of cathepsins D, B and S in phagocytic cells in the inflammatory infiltrate; and also may reveal a role for cathepsin B in lymphocytes.
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Affiliation(s)
- Fabian Lohoefer
- Clinic for Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technischen Universitaet Muenchen, Muenchen, Germany
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Søgaard R, Laustsen J, Lindholt JS. Cost effectiveness of abdominal aortic aneurysm screening and rescreening in men in a modern context: evaluation of a hypothetical cohort using a decision analytical model. BMJ 2012; 345:e4276. [PMID: 22767630 PMCID: PMC3390434 DOI: 10.1136/bmj.e4276] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the cost effectiveness of different screening strategies for abdominal aortic aneurysm in men, from the perspective of a national health service. SETTING Screening units at regional hospitals. PARTICIPANTS Hypothetical cohort of 65 year old men from the general population. MAIN OUTCOME MEASURES Costs (£ in 2010) and effect on health outcomes (quality adjusted life years (QALYs)). RESULTS Screening seems to be highly cost effective compared with not screening. The model estimated a 92% probability that some form of screening would be cost effective at a threshold of £20,000 (€24,790; $31,460). If men with an aortic diameter of 25-29 mm at the initial screening were rescreened once after five years, 452 men per 100,000 initially screened would benefit from early detection, whereas lifetime rescreening every five years would detect 794 men per 100,000. We estimated the associated incremental cost effectiveness ratios for rescreening once and lifetime rescreening to be £10,013 and £29,680 per QALY, respectively. The individual probability of being the most cost effective strategy was higher for each rescreening strategy than for the screening once strategy (in view of the £20,000 threshold). CONCLUSIONS This study confirms the cost effectiveness of screening versus no screening and lends further support to considerations of rescreening men at least once for abdominal aortic aneurysm.
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Affiliation(s)
- Rikke Søgaard
- Centre for Applied Health Services Research and Technology Assessment, Institute for Public Health, University of Southern Denmark, 5000 Odense, Denmark.
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30
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Duncan JL, Harrild KA, Iversen L, Lee AJ, Godden DJ. Long term outcomes in men screened for abdominal aortic aneurysm: prospective cohort study. BMJ 2012; 344:e2958. [PMID: 22563092 PMCID: PMC3344734 DOI: 10.1136/bmj.e2958] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether there is a relation between aortic diameter and morbidity and mortality in men screened for abdominal aortic aneurysm. DESIGN Prospective cohort study. SETTING Highland and Western Isles (a large, sparsely populated area of Scotland). PARTICIPANTS 8146 men aged 65-74. MAIN OUTCOME MEASURES Morbidity and mortality in relation to presence of abdominal aortic aneurysm and three categories of aortic diameter (≤ 24 mm, 25-29 mm, and ≥ 30 mm). RESULTS When screened, 414 men (5.1%) had an aneurysm (diameter ≥ 30 mm), 669 (8.2%) an aortic diameter of 25-29 mm, and 7063 (86.7%) an aortic diameter of ≤ 24 mm. The cohort was followed up for a median of 7.4 (interquartile range 6.9-8.2) years. Mortality was significantly associated with aortic diameter: 512 (7.2%) men in the ≤ 24 mm group died compared with 69 (10.3%) in the 25-29 mm group and 73 (17.6%) in the ≥ 30 mm group. The mortality risk in men with an aneurysm or with an aorta measuring 25-29 mm was significantly higher than in men with an aorta of ≤ 24 mm. The increased mortality risk in the 25-29 mm group was reduced when taking confounders such as smoking and known heart disease into account. After adjustment, compared with men with an aortic diameter of ≤ 24 mm, the risk of hospital admission for cardiovascular disease and chronic obstructive pulmonary disease was significantly higher in men with aneurysm and those with aortas measuring 25-29 mm. Men with an aneurysm also had an increased risk of hospital admission for cerebrovascular disease, atherosclerosis, peripheral arterial disease, and respiratory disease. In men with aortas measuring 25-29 mm, the risk of hospital admission with abdominal aortic aneurysm was significantly higher than in men with an aorta of ≤ 24 mm (adjusted hazard ratio 6.7, 99% confidence interval 3.4 to 13.2) and this increased risk became apparent two years after screening. CONCLUSIONS Men with abdominal aortic aneurysm and those with aortic diameters measuring 25-29 mm have an increased risk of mortality and subsequent hospital admissions compared with men with an aorta diameter of ≤ 24 mm. Consideration should be given to control of risk factors and to rescreening men with aortas measuring 25-29 mm at index scanning.
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Affiliation(s)
- John L Duncan
- Department of Surgery, Raigmore Hospital, Inverness IV2 3UJ, UK.
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Darwood R, Earnshaw JJ, Turton G, Shaw E, Whyman M, Poskitt K, Rodd C, Heather B. Twenty-year review of abdominal aortic aneurysm screening in men in the county of Gloucestershire, United Kingdom. J Vasc Surg 2012; 56:8-13. [PMID: 22503187 DOI: 10.1016/j.jvs.2011.12.069] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 12/16/2011] [Accepted: 12/19/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE An ultrasound screening program for abdominal aortic aneurysms (AAAs) in men began in Gloucestershire in 1990 and has been running for 20 years. This report examines the workload and results. METHODS We reviewed the screening database for attendance and outcome records from AAA surgery in Gloucestershire and postmortem and death certificate results looking for men who died from ruptured AAAs in the screening cohort. The setting was an AAA screening program in the county of Gloucestershire, UK. Men aged 65 were invited by year of birth to attend for an ultrasound screening for AAAs. Men with an aorta <2.6 cm were reassured and discharged; men with an aorta between 2.6 cm and 5.4 cm were offered follow-up surveillance; men with an aorta >5.4 cm were considered for intervention. We analyzed attendance rates, screening and surveillance outcomes, and intervention rates and outcomes over the 20 years of the study. RESULTS Some 61,982 men were invited, and 52,690 attended for screening (85% attendance). At first scan, 50,130 men (95.14%) had an aortic diameter <2.6 cm in diameter and were reassured and discharged; 148 men (0.28%) had an AAA >5.4 cm in diameter and were referred for possible treatment; 2412 (4.57%) had an aortic diameter between 2.6 and 5.4 cm and entered a program of ultrasound surveillance. The overall mean aortic diameter on initial scan fell from 2.1 cm to 1.7 cm during the study (reduction 0.015 cm/y, 95% confidence interval [CI], 0.0144-0.0156 cm/y; P < .0001). Some 631 patients with AAAs had intervention treatment with a perioperative mortality rate of 3.9%; during the same interval, 372 AAAs detected incidentally were treated, with a mortality rate of 6.7%. The number of ruptured AAAs treated annually in Gloucestershire fell during the study (χ(2) for trend = 18.31, df = 1; P < .0001). CONCLUSIONS Screening reduced the number of ruptured AAAs in Gloucestershire during the 20 years of the program. There has been a significant reduction of men with an abnormal aorta, as the mean aortic diameter of the 65-year-old male has reduced over 20 years.
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Affiliation(s)
- Rosie Darwood
- Gloucestershire Royal Hospital, Gloucester, United Kingdom
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Abstract
Fatal rupture of abdominal aortic aneurysm (AAA) remains a feared complication. Development of vascular surgery techniques over 50 years ago has fulfilled the promise of preventing rupture, but the significant morbidity associated with open repair causes physicians and their older patients pause. With the advent of less invasive endovascular techniques and devices, patients now have another viable treatment option. We review some of the important trials as well as discuss developments in the continually evolving field of endovascular repair of AAAs.
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McCollum P. Comments regarding ‘Implications of Attendance Patterns in Northern Ireland for Abdominal Aortic Aneurysm Screening’. Eur J Vasc Endovasc Surg 2011; 42:440-1. [DOI: 10.1016/j.ejvs.2011.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 04/26/2011] [Indexed: 11/25/2022]
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Beales L, Wolstenhulme S, Evans JA, West R, Scott DJA. Reproducibility of ultrasound measurement of the abdominal aorta. Br J Surg 2011; 98:1517-25. [PMID: 21861264 DOI: 10.1002/bjs.7628] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) screening and surveillance programmes use ultrasound imaging to measure the anteroposterior (AP) diameter of the infrarenal aorta. The aim of this study was to examine potential observer bias and variability in ultrasound measurements. METHODS Studies were identified for review via a MEDLINE database search (1966-2009). References supplied in accessed papers were also checked for potential relevance. Consistent search terminology, and inclusion and exclusion criteria were used to ensure quality of data. Nine papers were available to review. RESULTS Variation in intraobserver repeatability and interobserver reproducibility was identified. Six studies reported intraobserver repeatability coefficients for AP aortic diameter measurements of 1·6-4·4 mm. These were below the 5-mm level regarded as acceptable by the UK and USA AAA screening programmes. Five studies had interobserver reproducibility below the level of 5 mm. Four studies, however, reported poor reproducibility (range from -2 to +5·2 to -10·5 to +10·4); these differences may have had a significant clinical impact on screening and surveillance. CONCLUSION The studies used different methodologies with no standardized measurement techniques. Measurements were taken by observers from different medical disciplines of varying grade and levels of training. Standard training and formal quality assurance of ultrasound measurements are important components of an effective AAA screening programme.
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Affiliation(s)
- L Beales
- Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
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Affiliation(s)
- J J Earnshaw
- Department of Vascular Surgery, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK
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