Why are men offered screening for abdominal aortic aneurysms?
Men over the age of 65 are more likely to develop an abdominal aortic aneurysm than other groups of people are. That's why they are offered screening for abdominal aortic aneurysms. Screening lowers the risk of the aneurysm rupturing and leading to death. But treatment is associated with serious complications.
Abdominal aortic aneurysms rarely rupture, but if they do it is a life-threatening medical emergency. Screening for abdominal aortic aneurysms may be a good idea in men over the age of 65. It is done to discover larger aneurysms so that they can be operated on in order to prevent a rupture. Smaller bulges in the vessel are monitored on a regular basis to see whether they get larger.
But screening can have drawbacks too. Some of the aneurysms that are detected never would have caused any health problems. Knowing that you have an aneurysm can also be very distressing.
What does the examination tell us?
In the screening examination, ultrasound is used to measure the diameter of the abdominal aorta. All other steps are determined by the results of this measurement.
If 1,000 men aged 65 and over are tested, we can expect the following results:
- About 980 of the 1,000 men will not have an aneurysm: Their aortas will all have a diameter less than 3 cm. This is considered to be a "normal" size.
- About 18 of the 1,000 men will have a small to medium-sized aneurysm: If the abdominal aorta is 3 to 5.4 cm in diameter, experts recommend regular monitoring using ultrasound. If it expands more, surgery may be a good idea later on.
- About 2 of the 1,000 men will have a large aneurysm: If the diameter is 5.5 cm or more, the risk of rupture is relatively high. Surgery is usually recommended in these cases.
The following illustration shows once again the expected results of screening.
At a glance: What happens if 1,000 men aged 65 and over have screening?
- Even if the results are within the normal range, an aneurysm may still develop later on.
- Also, not every aneurysm that is discovered will cause health problems.
What are the advantages of screening?
Especially if the aneurysm is large, there is a risk that it will unexpectedly rupture within the next few years. That can be fatal.
Studies have looked into how many ruptures and deaths can be avoided by detecting aneurysms early on. The following estimate shows what can generally be expected during the 13 years following screening:
|. . . and eventually rupture||. . . and eventually lead to death|
|Without screening||in about 7 of them||in about 6 of them|
|With screening||in about 4 of them||in about 3 of them|
|In other words, out of 1,000 men . . .||. . . a rupture will be prevented in about 3.||. . . death as a result of the aneurysm will be prevented in about 3.|
What are the disadvantages of screening?
Some of the aneurysms detected in screening would have gone unnoticed if it hadn't been for the test. They wouldn't have ruptured, and check-ups or surgery wouldn't have been necessary. Unfortunately, it's not always possible to tell the difference between harmless aneurysms and dangerous ones.
It is estimated that about half of the aneurysms that are detected remain harmless. The small aneurysms in particular never would have caused any problems. This means that
about 20 out of the 1,000 men who have screening find out that they have an aneurysm. But the aneurysm never would have caused any trouble in about 10 of them.
What changes when you know you have an aneurysm?
The diagnosis can stir up very different and sometimes mixed emotions. Some men are glad that their aneurysm was discovered – the check-ups make them feel safe.
Other men wish they hadn't found out about it. Knowing about it can be scary and worrying.
Many men go on living with the feeling that their lives are in danger. Things like abdominal pain can then be unsettling. And many men stop doing certain things in everyday life out of fear that the aneurysm could rupture. They become more cautious and avoid physical exertion.
What happens during surgery?
There are two types of preventive surgery:
- The aneurysm is opened and replaced by an artificial blood vessel. An abdominal incision is required for this procedure.
- A tube is implanted in the aneurysm. This procedure involves making a small incision in the groin. The tube is inserted through the incision and into the aorta using a catheter, and pushed through to where the aneurysm is.
So the risks that the aneurysm poses should always be weighed against the risks of having the surgery. The decision regarding whether or not to have surgery will also depend on the man's general health and how he views the pros and cons of surgery himself.
Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Ultrasound screening for abdominal aortic aneurysms: Final report; commission S13-04. April 02, 2015. (IQWiG reports; volume 294).
Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Information for health insurance fund members on ultrasound screening for abdominal aortic aneurysms – addendum to commission S13-04: commission P16-01. October 13, 2016. (IQWiG reports; volume 449).
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