Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
J Vasc Surg. 2018 Apr;67(4):1298-1307. doi: 10.1016/j.jvs.2017.11.074. Epub 2018 Feb 21.
The objective of this review was to perform a rapid evidence summary to determine the prevalence of subaneurysmal aortic aneurysms, growth rates, and risk factors that modulate growth in average-risk men aged 65 years and older. Secondary objectives were to evaluate benefits and harms of lifelong ultrasound (US) surveillance and treatment outcomes for any large aneurysms that develop in the screened population.
We searched multiple databases (eg, Ovid MEDLINE, Embase Classic and Embase, and the Cochrane Library) on February 16, 2016. Using a liberal accelerated method, two reviewers screened titles and abstracts for relevance and subsequently screened full-text studies. General study characteristics (eg, country, study design, number of participants) and data (eg, number of men with subaneurysmal aortas, quality of life [QoL], mortality) were extracted. One reviewer performed data extraction and risk of bias assessments, and a second reviewer verified 100% of studies. Any disagreements were resolved by consensus.
The search identified 37 relevant studies ranging in size from 3 to 52,690 participants. Prevalence of subaneurysmal aortas ranged from 1.14% to 8.53%, and 55% to 88% of these men progressed to a 3.0-cm aneurysm by 5 years of follow-up. Risk factors for growth included the infrarenal aortic diameter at age 65 years, having a subaneurysmal aorta at age 65 years, and current smoking. The 36-Item Short Form Health Survey was the most commonly used tool to measure QoL, and QoL was typically lower in people with abdominal aortic aneurysm. Anxiety and depression levels did not differ significantly between comparison groups in any studies. Four studies reported on the number of men whose aorta was subaneurysmal on initial US who went on to surgery. Overall, 10% (57/547) of men initially measuring in the subaneurysmal range progressed to abdominal aortic aneurysm >5.4 cm and received elective surgery; 1% (6/547) received emergency surgery because of a ruptured aorta. Among those who did, mortality rates were much lower for elective (9.5%) vs emergency surgery (50%). Risk of bias was usually low for studies measuring prevalence and moderate and high for studies measuring psychological harms of screening and harms and benefits of surgery. Overall, using the Grading of Recommendations Assessment, Development, and Evaluation framework as guidance, the quality of the evidence was generally very low.
Because of the limited evidence and the low quality of the existing evidence, it is not possible to determine confidently whether men with abdominal aortas measuring 2.5 to 2.9 cm should be observed in a lifelong US surveillance program.
本综述旨在进行快速证据总结，以确定 65 岁及以上一般风险男性亚动脉瘤的患病率、增长率以及调节生长的危险因素。次要目标是评估在筛查人群中任何发展为大型动脉瘤的终生超声（US）监测和治疗结果的获益和危害。
我们于 2016 年 2 月 16 日在多个数据库（例如，Ovid MEDLINE、Embase Classic 和 Embase，以及 Cochrane 图书馆）中进行了检索。使用宽松的加速方法，两名审查员对标题和摘要进行了相关性筛选，然后对全文研究进行了筛选。提取了一般研究特征（例如，国家、研究设计、参与者数量）和数据（例如，患有亚动脉瘤的男性数量、生活质量[QoL]、死亡率）。一名审查员进行了数据提取和偏倚风险评估，第二名审查员验证了 100%的研究。任何分歧均通过共识解决。
搜索共确定了 37 项相关研究，研究规模从 3 例到 52690 例不等。亚动脉瘤的患病率从 1.14%到 8.53%不等，其中 55%到 88%的男性在 5 年随访期间进展为 3.0cm 的动脉瘤。生长的危险因素包括 65 岁时的肾下主动脉直径、65 岁时患有亚动脉瘤以及目前吸烟。36 项简短健康调查问卷是最常用于测量 QoL 的工具，且患有腹主动脉瘤的人群的 QoL 通常较低。在任何研究中，焦虑和抑郁水平在比较组之间均无显著差异。四项研究报告了初始 US 测量处于亚动脉瘤范围内的男性中，有多少人进展为腹主动脉瘤>5.4cm，并接受了择期手术。总体而言，最初处于亚动脉瘤范围内的 547 名男性中有 10%（57/547）进展为>5.4cm 的腹主动脉瘤并接受了择期手术；1%（6/547）因主动脉破裂而接受了紧急手术。对于接受手术的患者，择期手术（9.5%）的死亡率明显低于急诊手术（50%）。研究患病率的偏倚风险通常较低，而研究筛查的心理危害和手术的获益和危害的偏倚风险为中等到高。总体而言，使用推荐评估、制定与评估框架（Grading of Recommendations Assessment, Development, and Evaluation）作为指导，证据质量通常非常低。
由于证据有限且现有证据质量较低，无法确定 2.5 至 2.9cm 腹主动脉的男性是否应接受终生 US 监测计划。
