ORIGINAL ARTICLES   

International Angiology 2004 June;23(2):185-8

Copyright © 2004 EDIZIONI MINERVA MEDICA

lingua: Inglese

Screening men for aortic aneurysm

Calderwood R., Welch M.

Vascular Surgery Unit, Wythenshave Hospital, Manchester, UK

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.