Background: While the prognosis for abdominal aortic aneurysm (AAA) rupture is poor, ultrasound imaging is an accurate and reliable test for detecting AAAs before rupture.
Purpose: To examine the benefits and harms of population-based AAA screening.
Data Sources: MEDLINE (1994 to July 2004) supplemented by the Cochrane Library, reference lists of retrieved articles, and expert suggestions.
Study Selection: We included English-language abstracts with original data about the effectiveness or harms of screening or treating AAA. Randomized trials were selected for AAA population screening or treatment of small AAAs. Population studies were reviewed for AAA risk factors and data on adverse screening or treatment events from randomized trials and cohort studies.
Data Extraction: We extracted study information regarding patient population, study design, and clinical outcomes including harms. Studies were quality rated using predefined criteria.
Data Synthesis: We identified four population-based randomized controlled trials of AAA screening in men 65 years and older. Based on meta-analysis, an invitation to attend screening was associated with a significant reduction in AAA-related mortality (OR 0.57; 95% CI, 0.45 to 0.74). A meta-analysis of three trials revealed no significant difference in all-cause mortality (OR 0.98; 95% CI, 0.95 to 1.02). No significant reduction in AAA-related mortality was found in one study of AAA screening in women. Screening does not appear to be associated with significant physical or psychological harms. For 4.0–5.4 cm AAAs, immediate surgical repair, compared to surveillance with delayed repair, does not appear to improve either AAA-related mortality or all-cause mortality. Major treatment harms include 2 to 6% operative mortality rate and significant risk of major complications.
Conclusions: For men age 65 years and older, an invitation to attend AAA screening reduces AAA-related mortality.