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. 1997 Mar;79(2):90–95.

The case against a national screening programme for aortic aneurysms.

T R Cheatle 1
PMCID: PMC2502779  PMID: 9135233

Abstract

This review examines the assumptions underlying the calls for a national screening programme for aneurysms. It concludes that on the basis of published evidence, many of the necessary criteria for any putative screening programme are not met for this disease. Although the disease is an important cause of death, and a screening method is available, we lack basic knowledge about the natural history of the disease, especially small aneurysms, and about the cost-effectiveness of a screening programme. In particular, the treatment is an operation which, nationwide, carries a high mortality and is likely to be unacceptable to many patients. The consequences of such a programme would be to diagnose many small aneurysms, for which the best treatment remains unclear, and which will engender much unnecessary anxiety among patients so diagnosed.

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Selected References

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  1. Allardice J. T., Allwright G. J., Wafula J. M., Wyatt A. P. High prevalence of abdominal aortic aneurysm in men with peripheral vascular disease: screening by ultrasonography. Br J Surg. 1988 Mar;75(3):240–242. doi: 10.1002/bjs.1800750318. [DOI] [PubMed] [Google Scholar]
  2. Bengtsson H., Bergqvist D., Ekberg O., Janzon L. A population based screening of abdominal aortic aneurysms (AAA). Eur J Vasc Surg. 1991 Feb;5(1):53–57. doi: 10.1016/s0950-821x(05)80927-2. [DOI] [PubMed] [Google Scholar]
  3. Bengtsson H., Nilsson P., Bergqvist D. Natural history of abdominal aortic aneurysm detected by screening. Br J Surg. 1993 Jun;80(6):718–720. doi: 10.1002/bjs.1800800613. [DOI] [PubMed] [Google Scholar]
  4. Bengtsson H., Norrgård O., Angquist K. A., Ekberg O., Oberg L., Bergqvist D. Ultrasonographic screening of the abdominal aorta among siblings of patients with abdominal aortic aneurysms. Br J Surg. 1989 Jun;76(6):589–591. doi: 10.1002/bjs.1800760620. [DOI] [PubMed] [Google Scholar]
  5. Berridge D. C., Chamberlain J., Guy A. J., Lambert D. Prospective audit of abdominal aortic aneurysm surgery in the northern region from 1988 to 1992. Northern Vascular Surgeons Group. Br J Surg. 1995 Jul;82(7):906–910. doi: 10.1002/bjs.1800820716. [DOI] [PubMed] [Google Scholar]
  6. Bird D. L., Fox J. N., Ashley S., Imrie M. J. Results of the first year of breast cancer screening in a district hospital. Br J Surg. 1992 Sep;79(9):922–924. doi: 10.1002/bjs.1800790922. [DOI] [PubMed] [Google Scholar]
  7. Campbell W. B. Mortality statistics for elective aortic aneurysms. Eur J Vasc Surg. 1991 Apr;5(2):111–113. doi: 10.1016/s0950-821x(05)80673-5. [DOI] [PubMed] [Google Scholar]
  8. Collin J., Walton J. Is abdominal aortic aneurysm familial? BMJ. 1989 Aug 19;299(6697):493–493. doi: 10.1136/bmj.299.6697.493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cox R., Ware C. C. Abdominal aortic aneurysms in a district general hospital. Ann R Coll Surg Engl. 1981 May;63(3):177–180. [PMC free article] [PubMed] [Google Scholar]
  10. Cronenwett J. L., Murphy T. F., Zelenock G. B., Whitehouse W. M., Jr, Lindenauer S. M., Graham L. M., Quint L. E., Silver T. M., Stanley J. C. Actuarial analysis of variables associated with rupture of small abdominal aortic aneurysms. Surgery. 1985 Sep;98(3):472–483. [PubMed] [Google Scholar]
  11. Darke S. G. Provision of vascular services. Br J Surg. 1994 Aug;81(8):1110–1111. doi: 10.1002/bjs.1800810809. [DOI] [PubMed] [Google Scholar]
  12. Delin A., Ohlsén H., Swedenborg J. Growth rate of abdominal aortic aneurysms as measured by computed tomography. Br J Surg. 1985 Jul;72(7):530–532. doi: 10.1002/bjs.1800720709. [DOI] [PubMed] [Google Scholar]
  13. Diethrich E. B. Endovascular treatment of abdominal aortic occlusive disease: the impact of stents and intravascular ultrasound imaging. Eur J Vasc Surg. 1993 May;7(3):228–236. doi: 10.1016/s0950-821x(05)80002-7. [DOI] [PubMed] [Google Scholar]
  14. ESTES J. E., Jr Abdominal aortic aneurysm; a study of one hundred and two cases. Circulation. 1950 Aug;2(2):258–264. doi: 10.1161/01.cir.2.2.258. [DOI] [PubMed] [Google Scholar]
  15. Ellis M., Powell J. T., Greenhalgh R. M. Limitations of ultrasonography in surveillance of small abdominal aortic aneurysms. Br J Surg. 1991 May;78(5):614–616. doi: 10.1002/bjs.1800780529. [DOI] [PubMed] [Google Scholar]
  16. Fitzgerald P., Ramsbottom D., Burke P., Grace P., McAnena O., Croke D. T., Collins P., Johnson A., Bouchier-Hayes D. Abdominal aortic aneurysm in the Irish population: a familial screening study. Br J Surg. 1995 Apr;82(4):483–486. doi: 10.1002/bjs.1800820418. [DOI] [PubMed] [Google Scholar]
  17. Frame P. S., Fryback D. G., Patterson C. Screening for abdominal aortic aneurysm in men ages 60 to 80 years. A cost-effectiveness analysis. Ann Intern Med. 1993 Sep 1;119(5):411–416. doi: 10.7326/0003-4819-119-5-199309010-00010. [DOI] [PubMed] [Google Scholar]
  18. Geroulakos G., Nicolaides A. Infrarenal abdominal aortic aneurysms less than five centimetres in diameter: the surgeon's dilemma. Eur J Vasc Surg. 1992 Nov;6(6):616–622. doi: 10.1016/s0950-821x(05)80838-2. [DOI] [PubMed] [Google Scholar]
  19. Glimåker H., Holmberg L., Elvin A., Nybacka O., Almgren B., Björck C. G., Eriksson I. Natural history of patients with abdominal aortic aneurysm. Eur J Vasc Surg. 1991 Apr;5(2):125–130. doi: 10.1016/s0950-821x(05)80675-9. [DOI] [PubMed] [Google Scholar]
  20. Grimshaw G. M., Thompson J. M., Hamer J. D. A statistical analysis of the growth of small abdominal aortic aneurysms. Eur J Vasc Surg. 1994 Nov;8(6):741–746. doi: 10.1016/s0950-821x(05)80656-5. [DOI] [PubMed] [Google Scholar]
  21. Guirguis E. M., Barber G. G. The natural history of abdominal aortic aneurysms. Am J Surg. 1991 Nov;162(5):481–483. doi: 10.1016/0002-9610(91)90266-g. [DOI] [PubMed] [Google Scholar]
  22. Harris P. L. Reducing the mortality from abdominal aortic aneurysms: need for a national screening programme. BMJ. 1992 Sep 19;305(6855):697–699. doi: 10.1136/bmj.305.6855.697. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Hertzer N. R., Avellone J. C., Farrell C. J., Plecha F. R., Rhodes R. S., Sharp W. V., Wright G. F. The risk of vascular surgery in a metropolitan community. With observations on surgeon experience and hospital size. J Vasc Surg. 1984 Jan;1(1):13–21. [PubMed] [Google Scholar]
  24. Holdsworth J. D. Screening for abdominal aortic aneurysm in Northumberland. Br J Surg. 1994 May;81(5):710–712. doi: 10.1002/bjs.1800810527. [DOI] [PubMed] [Google Scholar]
  25. Johnson G., Jr, Avery A., McDougal E. G., Burnham S. J., Keagy B. A. Aneurysms of the abdominal aorta. Incidence in blacks and whites in North Carolina. Arch Surg. 1985 Oct;120(10):1138–1140. doi: 10.1001/archsurg.1985.01390340036006. [DOI] [PubMed] [Google Scholar]
  26. Lederle F. A., Wilson S. E., Johnson G. R., Reinke D. B., Littooy F. N., Acher C. W., Messina L. M., Ballard D. J., Ansel H. J. Variability in measurement of abdominal aortic aneurysms. Abdominal Aortic Aneurysm Detection and Management Veterans Administration Cooperative Study Group. J Vasc Surg. 1995 Jun;21(6):945–952. doi: 10.1016/s0741-5214(95)70222-9. [DOI] [PubMed] [Google Scholar]
  27. Lindholm L., Ejlertsson G., Forsberg L., Norgren L. Low prevalence of abdominal aortic aneurysm in hypertensive patients. A population-based study. Acta Med Scand. 1985;218(3):305–310. doi: 10.1111/j.0954-6820.1985.tb06129.x. [DOI] [PubMed] [Google Scholar]
  28. Louridas G., Reilly K., Perry M. O. The role of the aortic aneurysm diameter aortic diameter ratio in predicting the risk of rupture. S Afr Med J. 1990 Dec 1;78(11):642–643. [PubMed] [Google Scholar]
  29. Lucarotti M., Shaw E., Poskitt K., Heather B. The Gloucestershire Aneurysm Screening Programme: the first 2 years' experience. Eur J Vasc Surg. 1993 Jul;7(4):397–401. doi: 10.1016/s0950-821x(05)80256-7. [DOI] [PubMed] [Google Scholar]
  30. MacSweeney S. T., O'Meara M., Alexander C., O'Malley M. K., Powell J. T., Greenhalgh R. M. High prevalence of unsuspected abdominal aortic aneurysm in patients with confirmed symptomatic peripheral or cerebral arterial disease. Br J Surg. 1993 May;80(5):582–584. doi: 10.1002/bjs.1800800510. [DOI] [PubMed] [Google Scholar]
  31. Makin G. S. Changing fashions in the surgery of aortic aneurysms. Ann R Coll Surg Engl. 1983 Sep;65(5):308–310. [PMC free article] [PubMed] [Google Scholar]
  32. Marsh C. H. Experiences with abdominal aortic aneurysms in a district general hospital. Ann R Coll Surg Engl. 1980 Jul;62(4):294–296. [PMC free article] [PubMed] [Google Scholar]
  33. Mason J. M., Wakeman A. P., Drummond M. F., Crump B. J. Population screening for abdominal aortic aneurysm: do the benefits outweigh the costs? J Public Health Med. 1993 Jun;15(2):154–160. [PubMed] [Google Scholar]
  34. McFarlane M. J. The epidemiologic necropsy for abdominal aortic aneurysm. JAMA. 1991 Apr 24;265(16):2085–2088. [PubMed] [Google Scholar]
  35. McGregor J. C., Pollock J. G., Anton H. C. The diagnosis and assessment of abdominal aortic aneurysms by ultrasonography. Ann R Coll Surg Engl. 1976 Sep;58(5):388–392. [PMC free article] [PubMed] [Google Scholar]
  36. Morris G. E., Hubbard C. S., Quick C. R. An abdominal aortic aneurysm screening programme for all males over the age of 50 years. Eur J Vasc Surg. 1994 Mar;8(2):156–160. doi: 10.1016/s0950-821x(05)80451-7. [DOI] [PubMed] [Google Scholar]
  37. Nachbur B., Gut A., Sigrist S. Prognostic factors in the surgical treatment of aorto-iliac aneurysmal disease. Factors affecting survival and long-term results. J Cardiovasc Surg (Torino) 1987 Sep-Oct;28(5):469–478. [PubMed] [Google Scholar]
  38. Nevelsteen A., Kim Y., Meersman A., Suy R. Routine screening for unsuspected aortic aneurysms in patients after myocardial revascularization: a prospective study. Acta Cardiol. 1991;46(2):201–206. [PubMed] [Google Scholar]
  39. Nevitt M. P., Ballard D. J., Hallett J. W., Jr Prognosis of abdominal aortic aneurysms. A population-based study. N Engl J Med. 1989 Oct 12;321(15):1009–1014. doi: 10.1056/NEJM198910123211504. [DOI] [PubMed] [Google Scholar]
  40. Ogren M., Bengtsson H., Bergqvist D., Ekberg O., Hedblad B., Janzon L. Prognosis in elderly men with screening-detected abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 1996 Jan;11(1):42–47. doi: 10.1016/s1078-5884(96)80133-x. [DOI] [PubMed] [Google Scholar]
  41. Phillips S. M., King D. The role of ultrasound to detect aortic aneurysms in "urological" patients. Eur J Vasc Surg. 1993 May;7(3):298–300. doi: 10.1016/s0950-821x(05)80012-x. [DOI] [PubMed] [Google Scholar]
  42. Pilcher D. B., Davis J. H., Ashikaga T., Bookwalter J., Butsch D. W., Chase C. R., Ellman B. R., Vacek P. M., Lord C. F. Treatment of abdominal aortic aneurysm in an entire state over 7 1/2 years. Am J Surg. 1980 Apr;139(4):487–494. doi: 10.1016/0002-9610(80)90325-6. [DOI] [PubMed] [Google Scholar]
  43. Powell J. T., Greenhalgh R. M., Ruckley C. V., Fowkes F. G. Prologue to a surgical trial. Lancet. 1993 Dec 11;342(8885):1473–1474. doi: 10.1016/0140-6736(93)92939-q. [DOI] [PubMed] [Google Scholar]
  44. Quill D. S., Colgan M. P., Sumner D. S. Ultrasonic screening for the detection of abdominal aortic aneurysms. Surg Clin North Am. 1989 Aug;69(4):713–720. doi: 10.1016/s0039-6109(16)44878-4. [DOI] [PubMed] [Google Scholar]
  45. Rämö O. J., Grönlund S., Toivio I., Mokka R. E. Can we achieve better results by operating on smaller abdominal aortic aneurysms? Vasa. 1995;24(3):270–274. [PubMed] [Google Scholar]
  46. Samy A. K., Whyte B., MacBain G. Abdominal aortic aneurysm in Scotland. Br J Surg. 1994 Aug;81(8):1104–1106. doi: 10.1002/bjs.1800810807. [DOI] [PubMed] [Google Scholar]
  47. Samy A. K., Wilson B. J., Engeset J., Cooper G., Ah-See A. K. Abdominal aortic aneurysm: a 12-year experience in the Grampian region, Scotland. J R Coll Surg Edinb. 1995 Jun;40(3):180–184. [PubMed] [Google Scholar]
  48. Scott R. A., Ashton H. A., Kay D. N. Abdominal aortic aneurysm in 4237 screened patients: prevalence, development and management over 6 years. Br J Surg. 1991 Sep;78(9):1122–1125. doi: 10.1002/bjs.1800780929. [DOI] [PubMed] [Google Scholar]
  49. Scott R. A., Gudgeon A. M., Ashton H. A., Allen D. R., Wilson N. M. Surgical workload as a consequence of screening for abdominal aortic aneurysm. Br J Surg. 1994 Oct;81(10):1440–1442. doi: 10.1002/bjs.1800811010. [DOI] [PubMed] [Google Scholar]
  50. Scott R. A., Wilson N. M., Ashton H. A., Kay D. N. Influence of screening on the incidence of ruptured abdominal aortic aneurysm: 5-year results of a randomized controlled study. Br J Surg. 1995 Aug;82(8):1066–1070. doi: 10.1002/bjs.1800820821. [DOI] [PubMed] [Google Scholar]
  51. Scott R. A., Wilson N. M., Ashton H. A., Kay D. N. Is surgery necessary for abdominal aortic aneurysm less than 6 cm in diameter? Lancet. 1993 Dec 4;342(8884):1395–1396. doi: 10.1016/0140-6736(93)92756-j. [DOI] [PubMed] [Google Scholar]
  52. Simoni G., Pastorino C., Perrone R., Ardia A., Gianrossi R., De Cian F., Decian F., Cittadini G., Jr, Baiardi A., Bachi V. Screening for abdominal aortic aneurysms and associated risk factors in a general population. Eur J Vasc Endovasc Surg. 1995 Aug;10(2):207–210. doi: 10.1016/s1078-5884(05)80113-3. [DOI] [PubMed] [Google Scholar]
  53. Sloane J. P. Borderline lesions detected by breast screening. Br J Surg. 1994 Apr;81(4):481–483. doi: 10.1002/bjs.1800810402. [DOI] [PubMed] [Google Scholar]
  54. Smith F. C., Grimshaw G. M., Paterson I. S., Shearman C. P., Hamer J. D. Ultrasonographic screening for abdominal aortic aneurysm in an urban community. Br J Surg. 1993 Nov;80(11):1406–1409. doi: 10.1002/bjs.1800801117. [DOI] [PubMed] [Google Scholar]
  55. Stonebridge P. A., Callam M. J., Bradbury A. W., Murie J. A., Jenkins A. M., Ruckley C. V. Comparison of long-term survival after successful repair of ruptured and non-ruptured abdominal aortic aneurysm. Br J Surg. 1993 May;80(5):585–586. doi: 10.1002/bjs.1800800511. [DOI] [PubMed] [Google Scholar]
  56. Søreide O., Lillestøl J., Christensen O., Grimsgaard C., Myhre H. O., Solheim K., Trippestad A. Abdominal aortic aneurysms: survival analysis of four hundred thirty-four patients. Surgery. 1982 Feb;91(2):188–193. [PubMed] [Google Scholar]
  57. Webster M. W., Ferrell R. E., St Jean P. L., Majumder P. P., Fogel S. R., Steed D. L. Ultrasound screening of first-degree relatives of patients with an abdominal aortic aneurysm. J Vasc Surg. 1991 Jan;13(1):9–14. doi: 10.1067/mva.1991.25382. [DOI] [PubMed] [Google Scholar]
  58. van Laarhoven C. J., Borstlap A. C., van Berge Henegouwen D. P., Palmen F. M., Verpalen M. C., Schoemaker M. C. Chronic obstructive pulmonary disease and abdominal aortic aneurysms. Eur J Vasc Surg. 1993 Jul;7(4):386–390. doi: 10.1016/s0950-821x(05)80254-3. [DOI] [PubMed] [Google Scholar]

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