Screening for abdominal aortic aneurysms

Ruptured aneurysm of the abdominal aorta is a common preventable cause of d eath, accounting for 2% of all deaths in men over 60 years of age. Populati on screening could prevent such deaths. Aortic diameter (which can be measu red accurately on ultrasound) is a strong predictor of the risk of rupture, which is about 17% per year with aortic diameter greater than or equal to 6 cm, but below 0.5% per year with aortic diameter < 5 cm, with uncertainty regarding risk in the range 5.0-5.9 cm. Adopting an aortic diameter cut-of f of 6.0 cm, the detection rate is estimated to be 86% (that is, 86% of all men who would rupture an aortic aneurysm could be identified and offered s urgery) and the false positive rate only 0.6% (that is, 0.6% of men who wou ld not rupture an aortic aneurysm would be so identified). In men with aort ic diameter greater than or equal to 6 cm, the risk of rupture of 17% per y ear greatly outweighs the peri-operative mortality of about 5%. A national screening programme for men over 60 years of age could prevent 2000 deaths per year and should commence. Uncertainty remains regarding the frequency w ith which men with smaller aneurysms should be re-examined and the value of intervention among those with an aortic diameter of 5.0-5.9 cm, but the sc reening programme itself would generate data to help resolve these issues.