Screening for abdominal aortic aneurysm – an evidence-based review

Abstract

Objective: Review the evidence of mortality and adverse effects of screening for abdominal aortic aneurysm (AAA) in asymptomatic adults. Data Sources: National Guideline Clearinghouse, Guidelines Finder, Canadian Medical Association Practice Guidelines, Cochrane, DARE, Bandolier, MEDLINE and Index of Portuguese Medical Journals. Methods: We conducted a search for meta-analyses (MA), systematic reviews (SR), randomized clinical trials (RCT) and clinical practice guidelines (CPG), published between 01/01/2003 and 03/23/2013 in the Portuguese, Spanish, English and French languages, using the MeSH terms abdominal aortic aneurysm and mass screening. We used the Oxford Centre for Evidence-Based Medicine (CEBM) scale for assessment of levels of evidence (LE). Results: Of 337 articles obtained, 10 met the inclusion criteria (2 MA, 1 SR and 7 CPG). The SR and the MA selected showed that screening for AAA significantly decreased mortality in men aged between 65-75 years old, but not in women. A reduction in all-cause mortality was observed in one MA, which estimated a number needed to screen of 156. This is lower than the number needed to screen in current cancer screening programs. Screening doubled the number of elective surgeries and decreased the number of emergency surgeries for ruptured AAA by half. Conclusions: Consistent, good quality evidence demonstrated a reduction in mortality from AAA by screening asymptomatic men aged >= 65 years (LE1). The treatment of AAA is associated with significant risk of death and surgical complications, which may be acceptable in individuals at high risk.