Lindholt J S, Juul S, Fasting H, Henneberg E W
Vascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Viborg, Denmark.
Eur J Vasc Endovasc Surg. 2006 Dec;32(6):608-14. doi: 10.1016/j.ejvs.2006.06.008. Epub 2006 Aug 8.
At present, several regions and countries are considering screening for abdominal aortic aneurysm (AAA). However, The Chichester Aneurysms Screening Trial has reported poor long term benefit of screening for AAA. We therefore supplement previously published data with a preliminary analysis of the ten-year mortality from AAA, based upon population-based data until 2002 (7 years) and incomplete hospital-based information on deaths until 2005 (10 years).
In 1994 we started a randomised screening trial of 12,639 64-73 year-old males; 6,306 were controls, and 6,333 were invited to an abdominal ultrasound scan at their district hospital. Information on all deaths until 15.3.2005 was obtained from the Office of Civil Registration. Information on AAA related deaths was obtained from the national registry of Causes of Deaths from 1.4.1994 to 31.12.2001, and supplemented with AAA deaths known to the Danish National Patient Registry until 15.3.2005. Operations were obtained from the Danish National Vascular Registry from 1.4.1994 to 15.3.2005. Death certificates and medical records were reviewed by two independent assessors. The analyses were based on "intention to treat" from the date of randomisation.
The attendance rate was 76.6% and 191 (4.0%) had an AAA. The median observation time was 9.58 years. In the invited group 13 subjects were acutely operated on compared to 40 in the control group (Risk ratio: 0.32 (95% C.I. 0.17-0.60, P<0.001)), and 14 died due to AAA compared to 51 in the control group (Hazard ratio: 0.27 (95% C.I.: 0.15-0.49, P<0.001).
Over ten years, screening reduced mortality from AAA by 73%, and the frequency of emergency operations by 68%.
目前，几个地区和国家正在考虑对腹主动脉瘤（AAA）进行筛查。然而，奇切斯特动脉瘤筛查试验报告称，AAA筛查的长期益处不佳。因此，我们在先前发表的数据基础上，补充了基于截至2002年（7年）的人群数据以及截至2005年（10年）不完整的医院死亡信息对AAA十年死亡率的初步分析。
1994年，我们启动了一项针对12639名64 - 73岁男性的随机筛查试验；6306人为对照组，6333人被邀请到其所在地区医院进行腹部超声扫描。截至2005年3月15日的所有死亡信息来自民事登记办公室。1994年4月1日至2001年12月31日期间与AAA相关的死亡信息来自国家死亡原因登记处，并补充了丹麦国家患者登记处已知的截至2005年3月15日的AAA死亡信息。手术信息来自丹麦国家血管登记处1994年4月1日至2005年3月15日的数据。死亡证明和医疗记录由两名独立评估员进行审查。分析基于随机分组日期的“意向性治疗”原则。
出勤率为76.6%，191人（4.0%）患有AAA。中位观察时间为9.58年。在受邀组中，13名受试者接受了急诊手术，而对照组为40名（风险比：0.32（95%置信区间0.17 - 0.60，P < 0.001）），14人因AAA死亡，而对照组为51人（风险比：0.27（95%置信区间：0.15 - 0.49，P < 0.001））。
在十年间，筛查使AAA死亡率降低了73%，急诊手术频率降低了68%。
