PEARLS 26, October 2007, written by Brian R McAvoy

Clinical question
How effective is ultrasound screening for abdominal aortic aneurysm (AAA)?

Bottom line
Ultrasound screening, followed by appropriate management, significantly reduced deaths from AAA in men aged 65 to 79 years (NNT* 4). There was insufficient evidence to demonstrate benefit in women. The cost-effectiveness of a coordinated population-based screening programme may be acceptable but this needs further expert analysis. (*NNT = number needed to treat to benefit one individual.)

Caveat
The incidence of AAA in women is lower than for men. All-cause mortality was not significantly different between screened and unscreened groups 3 to 5 years after screening, which is to be expected given the relative infrequency of AAA as a cause of death.

Context
AAA is found in 5 to 10 per cent of men aged 65 to 79 years. The major complication is rupture, which has a mortality of 80 per cent for patients reaching hospital, and 50 per cent for those undergoing surgery for emergency repair. Currently, elective surgical repair is recommended for aneurysms discovered to be larger than 5.5cm to prevent rupture.

Cochrane Systematic Review
Cosford PA, Leng GC. Screening for abdominal aortic aneurysm. Cochrane Database of Systematic Reviews 2007, Issue 2. Article No. CD002945. DOI: 10.1002/14651858.CD002945.pub2. Note: This review contains 4 trials involving 127,891 men and 9342 women.