Department of Surgery, Falun County Hospital, SE-79182, Falun, Sweden.
Circulation. 2011 Sep 6;124(10):1118-23. doi: 10.1161/CIRCULATIONAHA.111.030379. Epub 2011 Aug 15.
Screening elderly men with ultrasound is an established method to reduce mortality from ruptured abdominal aortic aneurysm (AAA; Evidence Level 1a). Such programs are being implemented and generally consist of a single scan at 65 years of age. We report the results from screening 65-year-old men for AAA in middle Sweden.
All 65-year-old men (n=26,256), identified through the National Population Registry, were invited to an ultrasound examination. An AAA was defined as a maximum infrarenal aortic diameter of ≥30 mm. In total, 22 187 (85%) accepted, and 373 AAAs were detected (1.7%; 95% confidence interval, 1.5 to 1.9). With 127 previously known AAAs (repaired/under surveillance) included, the total prevalence of the disease in the population was 2.2% (95% confidence interval, 2.0 to 2.4). Self-reported smoking (odds ratio, 3.4; P<0.001), coronary artery disease (odds ratio, 2.0; P<0.001), and hypertension (odds ratio, 1.6; P=0.001) were independently associated with AAA in a multivariate logistic regression model. Thirteen percent of the entire population reported to be current smokers, one third of the frequency reported in the 1980s. The observed low prevalence of AAA was explained mainly by this change in smoking habits.
On the basis of the observed reduced exposure to risk factors, lower-than-expected prevalence of AAA among 65-year-old men, unchanged AAA repair rate, and significantly improved longevity of the elderly population, the current generally agreed-on AAA screening model can be questioned. Important issues to address are the threshold diameter for follow-up, the possible need for rescreening at a higher age, and selective screening among smokers.
使用超声筛查老年男性是降低腹主动脉瘤（AAA；证据水平 1a）破裂死亡率的既定方法。此类计划正在实施，通常包括在 65 岁时进行单次扫描。我们报告了在瑞典中部对 65 岁男性进行 AAA 筛查的结果。
通过国家人口登记册确定的所有 65 岁男性（n=26256）均被邀请接受超声检查。AAA 定义为肾下主动脉最大直径≥30mm。共有 22187 人（85%）接受了检查，发现 373 例 AAA（1.7%；95%置信区间，1.5 至 1.9）。如果将之前已知的 127 例 AAA（已修复/正在监测）包括在内，则该人群中该病的总患病率为 2.2%（95%置信区间，2.0 至 2.4）。在多变量逻辑回归模型中，自我报告的吸烟（比值比，3.4；P<0.001）、冠心病（比值比，2.0；P<0.001）和高血压（比值比，1.6；P=0.001）与 AAA 独立相关。整个人口中有 13%的人报告目前吸烟，这一比例低于 20 世纪 80 年代的报告频率。AAA 观察到的低患病率主要归因于吸烟习惯的改变。
根据观察到的危险因素暴露减少、65 岁男性 AAA 的预期患病率降低、AAA 修复率不变以及老年人口的预期寿命显著提高，目前普遍认可的 AAA 筛查模式可能值得质疑。需要解决的重要问题是随访的直径阈值、在更高年龄进行重新筛查的可能需要以及吸烟者的选择性筛查。
