Screening men for aortic aneurysm.

Abstract

AIM: Ruptured abdominal aortic aneurysm (rAAA) accounts for 10000 deaths annually in the UK. Deaths occur in the 6th and 7th decades with loss of potential years of life. Mortality rates of 5% to 8% are reported for elective AAA repair, but no significant improvement in emergency outcome, with community mortality remaining at 80% and operative mortality at 50%. Patients surviving have several years life expectancy, regardless of age, and good quality of life. The difference suggests that overall emergency mortality could be significantly reduced by earlier diagnosis with widespread screening of the at risk population. Previous studies suggest screening men over 65 years significantly reduces incidence of rupture and aneurysm related death. Patients with abdominal aortic aneurysm (AAA) have a high prevalence of coronary artery disease (CAD) and vice versa. There is mounting evidence that screening men for AAA reduces rAAA mortality, especially in high-risk groups. A limited screening study of CABG patients was introduced. METHODS: Patients on the waiting list for coronary artery bypass grafting (CABG) (n=118) had a single duplex scan of the abdominal aorta. Aortic diameter of >2.6 cm was considered abnormal. RESULTS: Eighteen AAAs were detected (15.3%), 5 required surgery, 13 underwent surveillance. Mean age at detection was 64.8 years with a range of ages between 60 and 72 years. CONCLUSION: Patients with symptomatic CAD have a high incidence of AAA, with significant risk of rupture in the perioperative period post-CABG. Screening should form part of the routine work-up for coronary revascularisation. Staged repair should be considered with AAA greater than 5.5 cm diameter.