Experts: Men Need Aneurysm Screening

Study Finds Ultrasound Can Cut Deaths in Half

From the WebMD Archives

Nov. 14, 2002 -- Each year some 25,000 Americans -- mostly elderly men -- die suddenly due to rupture of the largest blood vessel in the body. Now new research suggests these deaths could be cut in half by routinely screening those most at risk -- something some experts say should begin right away.

An abdominal aortic aneurysm is an abnormal bulge in the aorta, which is the main vessel supplying blood to the body. The weakened section of the blood vessel often grows like a balloon until it ruptures. Roughly 80% of patients who experience ruptured aortic aneurysms die, and men are six times more likely to have a rupture than women.

In two separate studies, researchers evaluated the effectiveness of aneurysm screening by comparing death rates among roughly 30,000 elderly men who were screened using ultrasound with a similar number of men who were not.

Deaths rates from aneurysm rupture were 50% lower in the screened men, leading the researchers to conclude that routine screening is justified in men who are 65 and older. Their findings are reported in the latest issues of The Lancet and the British Medical Journal.

"We have shown that you can reduce the risk of rupture in people with aneurysms with screening, so it doesn't make any sense not to screen," lead researcher Alan Scott, FRCS, of St. Richards Hospital, Chichester, England, tells WebMD. "Our findings also indicate that this one-time screening should be confined to older men."

Men who were found to have aortic aneurysms through screening were followed closely for an average of four years. Surgery was done to repair the aorta if the aneurysm grew to 5.5 cm, if it grew more than 1 cm per year, or became tender - all warning signs of possible rupture.

At follow-up, 65 aneurysm-related deaths had occurred in the screened group, compared to 113 aneurysm deaths in the group that was not screened.

But cost can be a big barrier to such widespread screening. In a separate analysis, the researchers estimated the cost of screening to be just under $100 per patient. Including expenses related to treatment, the cost per year of life gained was found to be approximately $45,000. But the researchers calculated that this cost would drop to $12,600 after a decade, once screening was widely adopted.

"The clinical analysis and this economic analysis provide clear evidence to support the cost effectiveness of this particular form of screening in elderly men," Scott and colleagues conclude.

American Heart Association spokesman Timothy J. Gardner, MD, tells WebMD the U.K. study makes a compelling argument for routine screening of older men. Garner is a professor of surgery at the University of Pennsylvania Medical Center.

Screening for aneurysms is not part of usual preventive care of most primary care physicians in the U.S., he says. "This research should challenge us because we have not focused on this. It is not hard to imagine this becoming a common recommendation for men over 65."

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SOURCES: The Lancet, Nov. 16, 2002 • British Medical Journal, Nov. 16, 2002 • Alan Scott, FRCS, MCH, St. Richards Hospital, Chichester, England * Timothy J. Gardner, MD, professor of surgery, University of Pennsylvania Medical Center, spokesman, American Heart Association.
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