Ultrasonographic screening for the detection of abdominal aortic aneurysms.

BACKGROUND The prevalence of abdominal aortic aneurysms (AAA) with a maximal diameter of 3 cm or more is age-dependent; among persons over age 65, it lies between 4% and 8% in men and between 0.5% and 1.5% in women. About 10% of all AAAs have a maximum diameter of 5 cm or more. The prognosis of ruptured AAA (rAAA) is dismal, with an overall mortality of at least 80%. Ultrasonography of the abdominal aorta is a safe and technically simple method of detecting AAAs. METHODS Evaluation of population-based, randomized studies of ultrasonographic screening for the detection of AAA, based on a selective review of the literature. RESULTS A meta-analysis of four randomized controlled studies showed that ultrasonographic screening was associated with a significant lowering of AAA-related mortality in men aged 65 to 80 after it had been performed for 3-5 years (risk reduction 44%, odds ratio [OR] 0.56, 95% confidence interval [CI] 0.44-0.72) and after it had been performed for 7-15 years (risk reduction 53%, OR 0.47, 95% CI 0.25-0.90). AAA screening was also associated with a significant lowering of the overall mortality after 7-15 years, but not in the first 5 years. Ultrasonographic screening led to a significant increase in the number of elective AAA operations performed and to a 50% reduction of the number of emergency operations for rAAA. CONCLUSION Ultrasonographic screening for AAA is a technically simple diagnostic test that is associated with a major reduction of AAA-related mortality. In view of the higher prevalence of AAA among the elderly, it is recommended that all men aged 65 or older and all men and women with a family history of AAA should be systematically screened. A national ultrasound screening program should be urgently implemented in Germany in order to bring about a major reduction in AAA-associated mortality.