Should we screen for abdominal aortic aneurysm? Yes

doi:10.1136/bmj.39517.443796.AD

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Stephen Brearley, consultant general and vascular surgeon

¹Whipps Cross University Hospital, London E11 1NR

vascusurg{at}btconnect.com

In January, the government announced five pilot screening programmes for aortic aneurysm in men aged 65 in England. Stephen Brearley describes the rationale for this proposal while James Johnson (doi: 10.1136/bmj.39514.494167.AD) argues that it is not without pitfalls

Around 5% of men aged between 65 and 74 have abdominal aortic aneurysms (maximum infrarenal aortic diameter of at least 3 cm).1 The prevalence is some six times lower in women. Aneurysms expand inexorably2 without causing symptoms until they rupture or the individual dies of another cause. When rupture occurs, barely half of the patients reach hospital alive.3 Of those who do, 40-60% do not survive to discharge, giving an overall mortality for ruptured aortic aneurysm in the region of 80%. Nearly 5000 people die of this condition each year in England and Wales.4

Some aneurysms are diagnosed before rupture occurs, but at present this is largely fortuitous. Conventional open repair of unruptured aneurysms below the renal arteries (95% of the total) carries a mean mortality of 9.5%,5 …