Epidemiology and screening strategies in abdominal aortic aneurysms,Epidemiologie und Screening-Strategien des abdominellen Aortenaneurysmas

Aim: To develop screening strategies for abdominal aortic aneurysms (AAA) based on epidemiology. Material and methods: The Medline database (PubMed) was searched under the key words “abdominal aortic aneurysm” AND “incidence and prevalence” and under “abdominal aortic aneurysm AND screening”. Results: In 2010 the highest prevalence rates of AAA per 100,000 population were seen in Australasians (310), high income North Americans (256), and in Western Europeans (245). The lowest prevalence rates were seen in North Africa/Middle East (124) and central Asia (113), with incidence rates mirroring prevalence. Both global AAA prevalence and incidence rates have declined over the last 20 years. The decline in AAA prevalence is largely attributable to decreased smoking, challenging the benefit of former AAA programs delivering screening to 65 year old men. Nearly two-thirds of all acute AAA events now occur at age 75 years or more. Therefore, it has been proposed to extend screening programs to men ≥75 years and special risk groups, e. g. women aged 75 years with hypertension. Even when accounting for decreasing AAA prevalence and incidence, the national AAA screening programs in England and Sweden are highly effective, due to a hospital mortality of less than 1% in repairing screen detected AAA. In contrast, in the USA AAA screening through a national program is nonexistent, but is left to physician discretion. Here, even with implementation of the SAAAVE Act, no reduction in hospitalization for AAA rupture or all-cause mortality has been noted. Conclusions: AAA screening is a highly effective prevention measure, depending on age, ethnic group and prevalence. Its success, however, depends largely upon how screening is organized.