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Ann Intern Med. 2014 Mar 4;160(5):321-9. doi: 10.7326/M13-1844.

Ultrasonography screening for abdominal aortic aneurysms: a systematic evidence review for the U.S. Preventive Services Task Force.

Abstract

BACKGROUND:

Long-term follow-up of population-based randomized, controlled trials (RCTs) has demonstrated that screening for abdominal aortic aneurysms (AAAs) measuring 3 cm or greater decreases AAA-related mortality rates in men aged 65 years or older.

PURPOSE:

To systematically review evidence about the benefits and harms of ultrasonography screening for AAAs in asymptomatic primary care patients.

DATA SOURCES:

MEDLINE, the Database of Abstracts of Reviews of Effects, the Cochrane Central Register of Controlled Trials (January 2004 through January 2013), clinical trial registries, reference lists, experts, and a targeted bridge search for population-based screening RCTs through September 2013.

STUDY SELECTION:

English-language, population-based, fair- to good-quality RCTs and large cohort studies for AAA screening benefits as well as RCTs and cohort and registry studies for harms in adults with AAA.

DATA EXTRACTION:

Dual quality assessment and abstraction of study details and results.

DATA SYNTHESIS:

Reviews of 4 RCTs involving 137,214 participants demonstrated that 1-time invitation for AAA screening in men aged 65 years or older reduced AAA rupture and AAA-related mortality rates for up to 10 and 15 years, respectively, but had no statistically significant effect on all-cause mortality rates up to 15 years. Screening was associated with more overall and elective surgeries but fewer emergency operations and lower 30-day operative mortality rates at up to 10- to 15-year follow-up. One RCT involving 9342 women showed that screening had no benefit on AAA-related or all-cause mortality rates.

LIMITATIONS:

Trials included mostly white men outside of the United States. Information for subgroups and about rescreening was limited.

CONCLUSION:

One-time invitation for AAA screening in men aged 65 years or older was associated with decreased AAA rupture and AAA-related mortality rates but had little or no effect on all-cause mortality rates.

PRIMARY FUNDING SOURCE:

Agency for Healthcare Research and Quality.

PMID:
24473919
DOI:
10.7326/M13-1844
[Indexed for MEDLINE]

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