Abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aortic artery. AAA rupture is a dramatic, lethal emergency condition with a high risk of death, even with treatment. The larger the dilation, the higher is the risk of rupture. Screening programs for AAA are used to identify aneurysms and individuals potentially at a high risk of AAA rupture or AAAs so-called suitable for repair. Those identified as suitable for repair, usually by ultrasound scan, are offered preventive (elective) surgery to reduce their individual risk of rupture. In Norway, the number of operations (urgent and elective) is approximately 800 per year.
The European Network for Health Technology Assessment (EUnetHTA) produces collaborative health technology assessments (HTAs) intended to be used by all countries to avoid duplication and waste of resources. The Norwegian Knowledge Centre for the Health Services (NOKC) has taken advantage of the HTA from EUnetHTA on the effect of AAA-screening published January 2013 to produce this systematic review. In terms of clinical effectiveness and safety, main conclusions are:
Evidence shows no reduction in overall mortality, neither in men nor in women, resulting from AAA screening (moderate quality of evidence).
AAA screening can however be beneficial in men over 65 years of age, as it can reduce AAA-related mortality by nearly half in the mid- and long-term (low to moderate quality of evidence).
In women aged 65 years and more, however, data indicate no change in AAA-related mortality (very low quality of evidence).
Safety of AAA screening is mainly related to the subsequent surgical intervention that follows detection of an AAA with high risk of rupture (eligible for repair).
Hospital volume, surgeon volume, and surgeon’s specialization in vascular surgery are factors associated with mortality when an AAA is eligible for repair.
Keywords: Aortic Aneurysm; Abdominal; Mass Screening.
Copyright ©2014 by The Norwegian Institute of Public Health (NIPH).