Gloucestershire Royal Hospital, Gloucester, United Kingdom.
J Vasc Surg. 2012 Jul;56(1):8-13. doi: 10.1016/j.jvs.2011.12.069. Epub 2012 Apr 12.
An ultrasound screening program for abdominal aortic aneurysms (AAAs) in men began in Gloucestershire in 1990 and has been running for 20 years. This report examines the workload and results.
We reviewed the screening database for attendance and outcome records from AAA surgery in Gloucestershire and postmortem and death certificate results looking for men who died from ruptured AAAs in the screening cohort. The setting was an AAA screening program in the county of Gloucestershire, UK. Men aged 65 were invited by year of birth to attend for an ultrasound screening for AAAs. Men with an aorta <2.6 cm were reassured and discharged; men with an aorta between 2.6 cm and 5.4 cm were offered follow-up surveillance; men with an aorta >5.4 cm were considered for intervention. We analyzed attendance rates, screening and surveillance outcomes, and intervention rates and outcomes over the 20 years of the study.
Some 61,982 men were invited, and 52,690 attended for screening (85% attendance). At first scan, 50,130 men (95.14%) had an aortic diameter <2.6 cm in diameter and were reassured and discharged; 148 men (0.28%) had an AAA >5.4 cm in diameter and were referred for possible treatment; 2412 (4.57%) had an aortic diameter between 2.6 and 5.4 cm and entered a program of ultrasound surveillance. The overall mean aortic diameter on initial scan fell from 2.1 cm to 1.7 cm during the study (reduction 0.015 cm/y, 95% confidence interval [CI], 0.0144-0.0156 cm/y; P < .0001). Some 631 patients with AAAs had intervention treatment with a perioperative mortality rate of 3.9%; during the same interval, 372 AAAs detected incidentally were treated, with a mortality rate of 6.7%. The number of ruptured AAAs treated annually in Gloucestershire fell during the study (χ(2) for trend = 18.31, df = 1; P < .0001).
Screening reduced the number of ruptured AAAs in Gloucestershire during the 20 years of the program. There has been a significant reduction of men with an abnormal aorta, as the mean aortic diameter of the 65-year-old male has reduced over 20 years.
1990 年，格洛斯特郡开始了一项针对男性腹主动脉瘤（AAA）的超声筛查计划，该计划已运行 20 年。本报告对其工作量和结果进行了评估。
我们查阅了格洛斯特郡 AAA 手术的筛查数据库中的就诊记录和结果，以及尸检和死亡证明结果，以寻找在筛查队列中死于破裂 AAA 的男性。该研究的背景是英国格洛斯特郡的一个 AAA 筛查项目。65 岁的男性按照出生年份被邀请参加 AAA 超声筛查。主动脉直径<2.6cm 的男性被安抚并出院；主动脉直径在 2.6cm 至 5.4cm 之间的男性接受随访监测；主动脉直径>5.4cm 的男性考虑进行干预。我们分析了 20 年来的就诊率、筛查和监测结果以及干预率和结果。
共有 61982 名男性受邀，其中 52690 名男性参加了筛查（85%的就诊率）。首次扫描时，50130 名男性（95.14%）的主动脉直径<2.6cm，被安抚并出院；148 名男性（0.28%）的 AAA 直径>5.4cm，被转诊接受可能的治疗；2412 名男性（4.57%）的主动脉直径在 2.6 至 5.4cm 之间，进入了超声监测项目。在研究期间，初次扫描的平均主动脉直径从 2.1cm 下降到 1.7cm（每年缩小 0.015cm，95%置信区间[CI]为 0.0144-0.0156cm/y；P<0.0001）。631 名患有 AAA 的患者接受了干预治疗，围手术期死亡率为 3.9%；在同一时期，372 例偶然发现的 AAA 接受了治疗，死亡率为 6.7%。格洛斯特郡每年接受治疗的破裂 AAA 数量在研究期间有所下降（趋势 χ(2)检验=18.31，df=1；P<0.0001）。
该计划实施 20 年来，筛查降低了格洛斯特郡破裂 AAA 的数量。随着 65 岁男性的主动脉平均直径在 20 年内缩小，异常主动脉的男性数量也显著减少。
