Radiological screening of abdominal aortic aneurysm in individuals over 65

Öz

Objective: The aims of this study were to determine the prevalence of AAA in aged 65 years and above that had been referred for US screening, the association between risk factors for atherosclerosis and AAA, and the effectiveness of screening a population aged 65 years and above with atherosclerosis risk factors using ultrasound (US).

Methods: Patients 65 years and over who had undergone US examination for any reason were invited to participate. The 600 patients (335 male, 265 female) who agreed to participate completed a survey of atherosclerosis risk factors. Aneurysm levels in patients with infrarenal or suprarenal AAA were measured using US. Statistical analysis was performed to identify the relationship between AAA and several atherosclerosis risk factors.

Results: Of the 600 patients, 35 (5.8%; 33 male and 2 female) patients were diagnosed with AAA. Males and females represented 94.3% and 5.7% of the AAA-diagnosed population, respectively, and 5.5% and 0.3% of the screened population, respectively. Thirty of the AAA-diagnosed patients (85.7%) were between 65 and 79 years and 5 (14.3%) 80 years and above. A significant relationship was found between AAA and advanced age, male sex, smoking, and coronary artery disease and an inverse relationship between AAA and diabetes mellitus (p<0.05).

Conclusion: Individuals age 65 and over with atherosclerotic risk factors for AAA should be screened to prevent possible rupture. Performance of US in radiology clinics is an effective means of identifying these patients.

Key words: Abdominal aortic aneurysm, Doppler ultrasonography, public screening, ultrasonography

Anahtar Kelimeler

• -

65 yaş ve üzeri kişilerde radyolojik olarak abdominal aorta anevrizması taraması

Öz

Amaç: Çalışmamızın amacı, radyoloji ünitesine başvuran 65 yaş ve üstü popülasyonda abdominal aort anevrizması (AAA) prevalansını ve ateroskleroz risk faktörleri ile AAA arasındaki ilişkiyi saptamaktır. Ayrıca 65 yaş ve üstü ateroskleroz risk faktörlerine sahip kişilerin US ile tarama etkinliğinin değerlendirilmesi amaçlanmıştır.Yöntemler: Herhangi bir nedenle hastaneye başvuran 65 yaş ve üstü 335 erkek, 265 kadın toplam 600 olgu alındı. AAA risk faktörlerinin sorgulandığı anket dolduruldu. US ile anevrizması saptanan olgularda anevrizma seviyesi, uzunluğu varsa tromboze segment belirtildi. AAA’nın prevelansı ve ateroskleroz risk faktörleri ile ilişkisini araştırdık. Bulgular: Toplamda 600 kişiden 35’i(%5,8) AAA tanısı aldı. AAA saptananların 33’ü erkek(%94,3), 2’si kadın(%5,7) olguydu. Erkeklerin %5,5’inde, kadınların %0,3’ünde AAA saptandı. AAA saptanan 35 olgunun 30’u (%85,7) 65-79 yaş aralığında, 5 olgu (%14,3) ise 80 yaş ve üzeriydi. Artan yaş, erkek cinsiyet, sigara kullanımı, koroner arter hastalığı ile AAA arasında istatistiksel olarak anlamlı ilişki, AAA ile diabetes mellitus arasında negatif ilişki saptandı (p

Anahtar Kelimeler

• Abdominal aort anevrizması, Doppler ultrasonografi, toplum taramaları, ultrasonografi

Kaynakça

1. Yucel EK, Fillmore DJ, Knox TA et al. Sonographic measurement
2. of abdominal aortic diameter: interobserver variability. J Ultrasound Med 1991;10:681-683.
3. Hermsen K, Chong WK. Ultrasound evaluation of abdominal
4. aortic and iliac aneursyms and mesenteric ischemia. Radiol Clin North Am 2004;32:33-36.
5. Köksoy C, Hazindaroğlu SM. Arteryel anevrizmalar. Türkiye
6. Klinikleri J Surgery 2003;8:41-49.
7. Guirguis-Blake JM, Beil TL, Sun X, et al. Primary Care Screening for Abdominal Aortic Aneurysm: A Systematic Evidence Review for the U.S. Preventive Services Task Force Evidence Syntheses, No.109. Agency for Healthcare Research and Quality (US); Jan 2014.
8. Bonamigo TP, Siqueira I. Screening for abdominal aortic aneurysms. Rev Hosp Clin Fac Med 2003;58:63-68.

9. Cornuz J, Pinto CS, Tevaearai H. Risk factors for asymptomatic abdominal aortic aneurysm. Systematic review and meta-analysis of population-based screening studies. Eur J Public Health 2004;14:343-349.
10. Lilienfeld DE, Gunderson PD, Sprafka JM, et al. Epidemiology
11. of aortic aneurysms. Mortality trends in the United States, 1951 to 1981. Arteriosclerosis 1987;7:637-643.
12. Lederle FA, Johnson Gr, Wilson SE. The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Arch Intern Med 2000;160:1425-1430.
13. Nordon IM, Hinchliffe RJ, Loftus IM, et al. Pathophysiology and epidemiology of abdominal aortic aneurysms Nat. Rev.Cardiol 2011;8:92-102.
14. Wilmink AB, Quick C, Collin J. Epidemiology and potential
15. for prevention of abdominal aortic aneurysm. Oxford screening programme for abdominal aortic aneurysms in men aged 65 to 74 years. Br J Surg 1998;85:155-162
16. Aune S, Amundsen SR, Evjensvold J, et al. Operative mortality
17. and long-term relative survival of patients operated on for asymptomatic abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 1995;9:293-298.
18. Sandridge LC, Baglioni AJ Jr, Kongable GL, et al. Evaluation
19. of the effect of endovascular options on infra-renal abdominal aortic aneurysm repair. Am Surg 2006;72:700-704.
20. Dillavou ED, Muluk SC, Makaroun MS. Improving aneurysmelated
21. outcomes: nationwide benefits of endovascularrepair. J Vasc Surg 2006;43:446-451.
22. Lederle FA. Ultrasonographic screening for abdominal aortic
23. aneurysms. Ann Intern Med 2003;139:516-522.
24. Janelle MG, Tracy LB. Ultrasonography screening for abdominal
25. aortic aneurysms: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2014;160:321-329.
26. Norman PE, Jamrozik K, Lawrence-Brown MM, et al. Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm.BMJ 2004;329:1259.
27. Ashton HA, Buxton MJ, Day NE, et al. The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet 2002;360:1531-1539.
28. Lindholt JS, Juul S. Screening for abdominal aortic aneurysms:
29. single centre randomised controlled trial. BMJ 2005;330:750.
30. Bengtsson H, Bergqvist D, Sternby N. Increasing prevalence
31. of abdominal aortic aneurysms. A necropsy study. Eur J Surg 1992;158:19-23.
32. Scott RA, Bridgewater SG, Ashton HA. Randomized clinical
33. trial of screening for abdominal aortic aneurysm in women. Br J Surg 2002;89:283-285.
34. DeRubertis G, Trocciola SM. Abdominal aortic aneurysm in women: prevalence, risk factors, and implications for screening. J Vasc Surg 46:630-635.
35. Wanhainen A, Lundkvist J, Bergqvist D, et al. Cost-effectiveness
36. of screening women for abdominal aortic aneurysm.J Vasc Surg 2006;43:908-914.
37. Perko MJ, Schroeder TV, Olsen PS et al. Natural history of abdominal aortic aneurysm: a survey of 63 patients treated nonoperatively. Ann Vasc Surg 1993;7:113-116.
38. JA Curci, S Liao, MD Huffman et al. Expression and localization
39. of macrophage elastase (matrix metalloproteinase-12)in abdominal aortic aneurysms. J Clin Invest. 1998 Dec 1;102:1900–1910.
40. Singh K, Bønaa KH, Jacobsen BK, et al. Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study: the Tromsø Study. Am J Epidemiol 2001;154:236-244.
41. Mattes E, Davis TME, Yang D, et al. Prevalence of abdominal aortic aneurysms in men with diabetes. Med J Aust 1997;166:630-633.
42. Takagi H, Umemoto T. A contemporary meta-analysis of the association of diabetes with abdominal aortic aneurysm. Int. Angiol 2015;34:375-382.
43. O’Kelly T, Heather B. General practice-based population screening for abdominal aortic aneurysms: a pilot study. Br J Surg 1989;76:469-480.
44. Smith FC, Grimshaw GM, Paterson IS, et al. Ultrasonographic
45. screening for abdominal aortic aneurysm in an urban community. Br J Surg 1993;80:1406-1409.