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Abdominal Aortic Aneurysm Experience from a Screening Study in Northern Sweden

Wanhainen, Anders, 1966- (author)
Uppsala universitet, Institutionen för kirurgiska vetenskaper
Uppsala universitet Medicinska och farmaceutiska vetenskapsområdet. Medicinska fakulteten. Institutionen för kirurgiska vetenskaper. (creator_code:org_t)
ISBN 91-554-6008-9
Uppsala : Acta Universitatis Upsaliensis, 2004
English 96 s.
Series: Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, 0282-7476 ; 1364
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  • Abdominal aortic aneurysm (AAA) is a common problem with life-threatening consequences and was suspected to be a serious health problem in Norsjö, a municipality in northern Sweden. A screening study was undertaken to investigate the prevalence, risk factors associated with AAA and the effect of screening on quality of life (QoL). All men and women, aged 65-75 years, were invited to an ultrasonography (US) examination, 91% attended and 92 subjects were also evaluated with computed tomography (CT).Depending on diagnostic criteria, the AAA prevalence was 3.6-16.9% in men and 0.8-9.4% in women. Seventy-five percent of the differences between US- and CT anteroposterior measurements were less than 5 mm. A decrease in mental health was observed among AAA patients with low baseline SF-36 scale scores. Elevated cholesterol at age 60 years were associated with screening detected AAA after 12 years of follow-up. Smoking, atherosclerosis and having a first degree relative with AAA were associated with AAA at screening. Compared to blood samples obtained 12 years prior to screening an elevation of hsCRP over time was observed among AAA patients. Based on a systematic review of the literature, different screening strategies were analysed in a Markov cohort model. The cost per life year gained ranged from $8 309 to $14 084 and was estimated to $10 474 when 65 year old men were screened once.Conclusions: The highest prevalence of AAA ever reported, in a population-based screening program, was found in Norsjö. The risk of having an AAA at screening showed a strong but complex association with atherosclerosis and its risk factors, genetic and inflammatory mechanisms may also be important. Screening 65-year-old men for AAA may be cost-effective, but QoL aspects on the cost-effectiveness of AAA screening merits further investigation.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

Keyword

Surgery
abdominal aortic aneurysm
definition
prevalence
ultrasonography
computed tomography
variability
quality of life
SF-36
risk factor
cholesterol
smoking
CRP
heredity
atherosclerosis
screening
cost-effectiveness
cost-utility
Kirurgi
MEDICINE Surgery
MEDICIN Kirurgi

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dok (subject category)
vet (subject category)

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