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  • Title: Assessment of the criteria for elective surgery in screen-detected abdominal aortic aneurysms.
    Author: Scott RA, Kim LG, Ashton HA, Multi-centre Aneurysm Screening Study Group.
    Journal: J Med Screen; 2005; 12(3):150-4. PubMed ID: 16156946.
    Abstract:
    OBJECTIVES: Apart from aortic diameter, two other widely used criteria for considering surgery in screen-detected abdominal aortic aneurysms (AAAs)--annual aortic expansion > or =1.0 cm and presence of symptoms attributable to the AAA--are based on accepted practice and AAA expansion rates, rather than direct evidence. The Multi-centre Aneurysm Screening Study (MASS) enables assessment of their contribution to this risk reduction. METHODS: MASS employs three criteria for referral for considering elective open surgery: maximum aortic diameter > or =5.5 cm, rapid aortic expansion (> or =1.0 cm/year), and/or the presence of symptoms attributable to the AAA. Data from MASS are used to examine the value of these criteria in practice. RESULTS: No patients were referred for symptoms alone. Of those referred for rapid expansion, 88% were returned to surveillance, compared with only 12% of those referred for diameter > or =5.5 cm at initial scan, and 34% of those referred for diameter > or =5.5 cm at a follow-up scan. Return to surveillance following referral for rapid expansion was strongly associated with aortic diameter (age-adjusted odds ratio for return 0.89 per mm, 95% confidence interval 0.79-1.00). Of those 5.0-5.4 cm at the time of referral for rapid expansion who were returned, 31% reached 5.5 cm during a median post-referral follow-up of 0.9 years. Among those referred for expansion, the rupture rate was only 8 per 1000 person-years of follow-up prior to reaching 5.5 cm. CONCLUSIONS: A single criterion for considering elective surgery is recommended in screen-detected AAA, based on a maximum aortic diameter of > or =5.5 cm. This criterion detects the majority of those at risk from rupture, and is simple to assess.
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