Screening for abdominal aortic aneurysms: single centre randomised controlled trial [published correction appears in BMJ 2005; 331: 876]

Aarhus University, Aarhus, Central Jutland, Denmark
BMJ (online) (Impact Factor: 17.45). 04/2005; 330(7494):750. DOI: 10.1136/bmj.38369.620162.82
Source: PubMed


To determine whether screening Danish men aged 65 or more for abdominal aortic aneurysms reduces mortality.
Single centre randomised controlled trial.
All five hospitals in Viborg County, Denmark.
All 12,639 men born during 1921-33 and living in Viborg County. In 1994 we included men born 1921-9 (64-73 years). We also included men who became 65 during 1995-8.
Men were randomised to the intervention group (screening by abdominal ultrasonography) or control group. Participants with an abdominal aortic aneurysm > 5 cm were referred for surgical evaluation, and those with smaller aneurysms were offered annual scans.
Specific mortality due to abdominal aortic aneurysm, overall mortality, and number of planned and emergency operations for abdominal aortic aneurysms.
4860 of 6333 men were screened (attendance rate 76.6%). 191 (4.0% of those screened) had abdominal aortic aneurysms. The mean follow-up time was 52 months. The screened group underwent 75% (95% confidence interval 51% to 91%) fewer emergency operations than the control group. Deaths due to abdominal aortic aneurysms occurred in nine patients in the screened group and 27 in the control group. The number needed to screen to save one life was 352. Specific mortality was significantly reduced by 67% (29% to 84%). Mortality due to non-abdominal aortic aneurysms was non-significantly reduced by 8%. The benefits of screening may increase with time.
Mass screening for abdominal aortic aneurysms in Danish men aged 65 or more reduces mortality.

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Available from: Jes Lindholt, Apr 10, 2015
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    • "The results provided reliable evidence of the benefit of screening for abdominal aortic aneurysm. Lindholt, et al.17 performed the screening to determine whether screening Danish men aged 65 years or more for AAA reduced mortality. 4860 men were screened. "
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    ABSTRACT: Purpose It is important to know the normal diameter of artery throughout the body so that clinicians are able to determine when an artery becomes aneurysmal. However, there are no previous studies on the normal diameter of arteries in the general Korean population. The purpose of this article is to determine the normal reference diameters of the abdominal aorta and iliac arteries in the Korean population. Materials and Methods We recruited the study population from three cities in Korea for the abdominal aortic aneurysm (AAA) screening. We measured the diameter of the aorta and iliac arteries. We analyzed the reference diameter of the population without AAA. The results were analyzed by Student's t-test and ANOVA on SPSS version 19. A p value <0.05 was considered to be statistically significant. Results One thousand two hundred and twenty-nine people were enrolled. 478 men and 751 women, with a mean age of 63.9±10.1 years (range 50 to 91) were examined. Eleven out of 1229 (0.89%) were diagnosed with AAA. In the population of 1218 people without AAA, the mean diameters (cm) of male/female were 2.20/2.11 (p<0.001) at suprarenal, 2.04/1.90 (p<0.001) at renal, 1.90/1.79 (p<0.001) at infrarenal, 1.22/1.17 (p<0.001) at right iliac and 1.47/1.15 (p=0.097) at the left iliac, respectively. There was a significantly larger diameter in the male population. The diameter of each level increased with age. Conclusion The normal reference diameter of the infrarenal abdominal aorta in the Korean population is 1.9 cm in males and 1.79 cm in females. The diameter of the abdominal aorta increases with age.
    Full-text · Article · Jan 2013 · Yonsei medical journal
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    • "The relative risk reduction of the screening program in AAArelated mortality was 66%, but the risk reduction in all-cause mortality amounted merely 2% (Lindholt et al., 2010). The number needed to screen to save one life was 352 (Lindholt et al., 2005). Pooled mid-term and long-term effects of screening on AAA-related and total mortality were examined by Lindholt & Norman, 2008 in a meta-analysis including new data not considered in the Cochrane review (Cosford & Leng, 2007). "
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    ABSTRACT: This review comments on prognosis and treatment of abdominal aortic aneurysm (AAA) with respect to rupture prevention by screening. The data demonstrate that a postoperative mortality rate of 1-3% has to be expected with endovascular aneurysm repair (EVAR) compared to 3-5% with open repair (OR), depending on the kind of study and patient risk factors. However, the slightly lower short-term rates of death with EVAR do not give enough evidence so far to change the recommendation that patients with asymptomatic AAA measuring not till £5.5 cm should undergo repair to eliminate the risk of rupture. Whether the introduction of EVAR has reduced the annual number of ruptured AAA is investigated at the moment. In-hospital operative mortality of ruptured AAA remains high and ranges between 30% to 50%, depending on patient selection and kind of rupture (free or covered perforation). Long-term follow-up of patients with repaired AAA demonstrates an unfavorable prognosis of these patients compared to the general population with the corresponding age. There is good evidence that screening for AAA in men aged 65 to 75 years who have ever smoked leads to a decreased AAA-specific mortality with a defensible cost-effectiveness. Nevertheless, mass screening for AAA is controversial since screening may have only small contributions to population mortality. The cost-effectiveness of screening may be substantially reduced if the indication for operation would be gradually expanded, increasing the case load of repaired AAA with smaller diameters (£5.5 cm). The psychological effects of screening on patients with smaller AAA left with the knowledge that they have a potentially life threatening condition that needs no treatment at the moment, are unknown. It is suggested that ultrasound examination of the abdomen by the general practitioner during routine check up would also increase the number of incidental detection of AAA in the selected risk group, without the serious psychological consequences of mass screening.
    Full-text · Chapter · Sep 2011
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    • "Ultrasonographic screening is a valid, suitable, and acceptable method, which is sensitive (98%) and specific (99%). Persons at the highest risk of AAA attend screening more frequently than persons at low risk,7 and repeated screening is only required in 5% of the initially negative cases.8 "
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    ABSTRACT: Aneurysm of the abdominal aorta (AAA) is a particular, specifically localized form of atherothrombosis, providing a unique human model of this disease. The pathogenesis of AAA is characterized by a breakdown of the extracellular matrix due to an excessive proteolytic activity, leading to potential arterial wall rupture. The roles of matrix metalloproteinases and plasmin generation in progression of AAA have been demonstrated both in animal models and in clinical studies. In the present review, we highlight recent studies addressing the role of the haemoglobin-rich, intraluminal thrombus and the adventitial response in the development of human AAA. The intraluminal thrombus exerts its pathogenic effect through platelet activation, fibrin formation, binding of plasminogen and its activators, and trapping of erythrocytes and neutrophils, leading to oxidative and proteolytic injury of the arterial wall. These events occur mainly at the intraluminal thrombus-circulating blood interface, and pathological mediators are conveyed outwards, where they promote matrix degradation of the arterial wall. In response, neo-angiogenesis, phagocytosis by mononuclear cells, and a shift from innate to adaptive immunity in the adventitia are observed. Abdominal aortic aneurysm thus represents an accessible spatiotemporal model of human atherothrombotic progression towards clinical events, the study of which should allow further understanding of its pathogenesis and the translation of pathogenic biological activities into diagnostic and therapeutic applications.
    Full-text · Article · Oct 2010 · Cardiovascular Research
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