Targeted abdominal aortic aneurysm screening: a retrospective review of a high-volume Irish tertiary vascular centre.

BACKGROUND

Despite modern surgical and resuscitative techniques, ruptured abdominal aortic aneurysms (AAA) carry a high mortality rate. Screening programmes aim to identify intact AAA in time for prophylactic repair. Ireland does not have a national screening programme for AAA. The Beaumont Hospital vascular unit serves as a tertiary referral centre for approximately one million people and runs an opportunistic AAA screening programme based on risk factors. One year of screening duplex were audited for AAA pick-up rate.Despite modern surgical and resuscitative techniques, ruptured abdominal aortic aneurysms (AAA) carry a high mortality rate. Screening programmes aim to identify intact AAA in time for prophylactic repair. Ireland does not have a national screening programme for AAA. The Beaumont Hospital vascular unit serves as a tertiary referral centre for approximately one million people and runs an opportunistic AAA screening programme based on risk factors. One year of screening duplex were audited for AAA pick-up rate.

METHODS

A retrospective audit of all AAA screening duplexes performed in the Beaumont Hospital Vascular Lab over a single year (January-December 2020) was performed. Indications for screening and outcomes were documented.

RESULTS

Over 12 months, 198 screening duplex were performed. The majority of screened patients were male (64.6%, n=128) with a mean age of 72 years (+/- SD 10.64). Indications for screening included atherosclerotic disease (n=130, 65.6%), family history of AAA (n=23, 11.6%), suspected AAA on x-ray or bedside ultrasound (n=18, 9%) and eight were prompted by examination findings. Out of 198 duplexes, there was an AAA detection rate of 11.1% (n=22). Of the 22 AAAs confirmed on screening duplex, two (9%) were over threshold for surgical repair. Co-morbidities associated with AAA, there were 10 (45%) patients who were either active smokers or ex-smokers and 13 (59%) are hypertensive. At three-year follow-up, three patients have undergone elective EVAR and one has died of non-vascular causes.

CONCLUSION

Opportunistic screening for AAA in patients attending the vascular department based on atherosclerotic risk factors is a reasonable policy. Next steps should include a local cost-benefit analysis and developing formal departmental criteria for screening referral.