Screen at-risk for aortic aneurysm

OLDER patients with multiple risk factors for abdominal aortic aneurysm may benefit from an ultrasound to screen for it, according to a leading vascular surgeon.

The key risk factors were male gender, a history of smoking and/or coronary heart disease, and family history of abdominal aortic aneurysm, said James Cook University’s Professor Jonathan Golledge, director of vascular surgery at Townsville Hospital.

Professor Golledge was commenting on Danish research suggesting that screening for an abdominal aortic aneurysm was more cost-effective than not screening if high-risk individuals were rescreened once after five years.

According to the study, an additional 452 men per 100,000 aged over 65 years would benefit from early detection with such a screening program. However, lifetime rescreening every five years would not be cost-effective, the researchers found.

Targeted screening has been implemented in England and Scotland.

But Professor Golledge said national screening was not under consideration in Australia as the incidence of abdominal aortic aneurysm was falling, likely due in part to reduced smoking rates.

At the same time, incidental detection of aneurysm was increasing due to wider use
of imaging to investigate patients with abdominal symptoms, he said.

“All of that has washed out into some concern that the detection rates are going to be quite a bit lower than the original trials showed and therefore that may impact on the economic value of the cost of identifying asymptomatic cases,” Professor Golledge said.

Some incidental screening may be occurring with GPs ordering imaging for individuals at high risk, he said.

“From a patient’s point of view… detecting an aneurysm while it’s asymptomatic…is obviously much more pre­ferable.”        
BMJ 2012; online 5 July