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Randomisierte Studien mit EBM-Level 1 beweisen es

Ein Screeningprogramm für abdominelle Aortenaneurysmen ist sinnvoll!

Randomised studies with EBM level 1 prove it

A screening programme for abdominal aortic aneurysms makes sense

Zusammenfassung

Die Ergebnisse randomisierter kontrollierter Studien zum Screening älterer Männer hinsichtlich abdominaler Aortenaneurysmen (AAA) sind veröffentlicht worden. Daher wurde eine systematische Überprüfung und Metaanalyse durchgeführt, um die gepoolten Effekte einschätzen zu können. Hierzu erfolgte eine Medline-Recherche (PubMed) mit den Schlüsselwörtern „screening“ und „Aortenaneurysma“ hinsichtlich randomisierter kontrollierter Studien in englischer Sprache. Es wurden 4 Studien identifiziert: die „Chichester Study“ (UK/England), die „Multicentre Aneurysm Screening Study“ (MASS; UK, England), die „Western Australian Aneurysm Screening Study“ (AUS) und die Viborg-Studie (Dänemark). Die mittelfristigen (3,5–5,0 Jahre) und langfristigen (7–15 Jahre) Effekte als Odds-Ratio (OR) mit 95%-Konfidenzintervall (-KI) wurden berechnet. Die mittelfristige Analyse ergab, dass durch das Screening die Wahrscheinlichkeit einer AAA-Ruptur um 47% signifikant sank, die AAA-bedingte Letalität (nach Ausschluss der Männer >80 Jahren) um 49% zurückging und auch die Gesamtletalität reduziert werden konnte (OR=0,93; 95%-KI=0,90–0,96). Die Zahl der geplanten Operationen stieg um das 3fache (p<0,05) und die Wahrscheinlichkeit von Notoperationen reduzierte sich um 45% (p<0,05). Die langfristigen gepoolten Ergebnisse zeigten eine signifikante Reduktion der Wahrscheinlichkeit sowohl der AAA-Ruptur als auch der AAA-bedingten Letalität um jeweils 47% sowie einen signifikante Rückgang der Gesamtletalität (OR=1,77; 95%-KI=0,92–0,97). Insgesamt wurden bei den einbestellten Männern nach 7–15 Jahren 1,7-mal mehr Operationen durchgeführt als bei den Kontrollpersonen (OR=1,77; 95%-KI=1,57–1,99). Das AAA-Screening senkt die Wahrscheinlichkeit von Rupturen und AAA-bedingten Todesfällen jeweils um etwa 50% und die Gesamtmortalität um etwa 6–7%, wobei Unterschiede bestehen, die das lokale Kosten-Nutzen-Verhältnis des Screenings beeinflussen können.

Abstract

Results have been published of randomised controlled studies on the screening of elderly men for abdominal aortic aneurysms (AAA). A systematic review and meta-analysis was therefore carried out in order to be able to assess the pooled effects. A Medline search (PubMed) for randomised controlled studies was carried out using the key words “screening” and “aortic aneurysms” in English. The medium-term (3.5-5 years) and long-term (7-15 years) effects were calculated as the odds ratio with a 95% confidence interval. Four studies were identified, the “Chichester Study” (UK/England), the “Multicentre Aneurysm Screening Study” (MASS) (UK/England), the “Western Australian Aneurysm Screening Study” (AUS) and the “Viborg Study” (Denmark). The analysis showed that the probability of an AAA rupture fell significantly by 47% as a result of screening, AAA-related mortality (after men over the age of 80 years were excluded) decreased by 49% and overall mortality was also reduced (OR 0.93; 95% CI: 0.90-0.96). The number of planned operations increased 3-fold (p<0.05) and the probability of emergency operations decreased by 45% (p<0.05). The long-term pooled results showed a significant reduction of 47% in the probability of both AAA rupture and AAA-related mortality and a significant decrease in overall mortality (OR 1.77; 95% CI: 0.92-0.97). Overall, 1.7 times more operations were carried out on the men invited for screening than on the controls (OR 1.77; 95% CI: 1.57; 1.99). AAA screening reduces the probability of rupture and AAA-related mortality by about 50% each and overall mortality by about 6-7%, although there are differences which might have an impact on local cost-benefit ratio of the screening.

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Literatur

  1. 1.

    Lindholt JS (1998) Considerations and experiences of screening for abdominal aortic aneurysms. Fadl’s Forlag, Copenhagen

  2. 2.

    Wilmink AB, Quick CR (1998) Epidemiology and potential for prevention of abdominal aortic aneurysm. Br J Surg 85(2):155–162

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Griffiths DAT, Ruitenberg EJ (1986) Preventive screening of adults. An evaluation of methods und programmes. Council of Europe, Paris

  4. 4.

    Wilson JMG, Jungner F (1968) Principles and practise of screening for disease. WHO Health Papers No. 34

  5. 5.

    Lindholt JS, Juul S, Henneberg EW, Fasting H (1998) Is screening for abdominal aortic aneurysm acceptable to the population? Selection and recruitment to hospital-based mass screening for abdominal aortic aneurysm. J Public Health Med 20(2):211–217

    PubMed  CAS  Google Scholar 

  6. 6.

    Lindholt JS, Vammen S, Juul S et al (1999) The validity of ultrasonographic scanning as screening method for abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 17(6):472–475

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    UK Small Aneurysm Trial Participants (1998) Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet 352:1649–1655

    Article  Google Scholar 

  8. 8.

    Lederle FA, Wilson SE, Johnson GR et al (2002) Immediate repair compared with surveillance of small abdominal aortic aneurysms, N Engl J Med 346(19):1437–1444

    Google Scholar 

  9. 9.

    Lederle FA, Johnson GR, Wilson SE et al (1993) Quality of life, impotence, and activity level in a randomized trial of immediate repair versus surveillance of small abdominal aortic aneurysm. J Vasc Surg 38(4):745–752

    Article  Google Scholar 

  10. 10.

    Lindholt JS, Vammen S, Fasting H, Henneberg EW (2000) Psychological consequences of screening for abdominal aortic aneurysm and conservative treatment of small abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 20(1):79–83

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    UK Small Aneurysm Trial Management Committee (1998) Health service costs and quality of life for early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet 352:1656–1660

    Article  Google Scholar 

  12. 12.

    Scott RA, Wilson NM, Ashton HA, Kay DN (1995) Influence of screening on the incidence of ruptured abdominal aortic aneurysm: 5-year results of a randomized controlled study. Br J Surg 82(8):1066–1070

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Ashton HA, Gao L, Kim LG et al (2007) Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms 1. Br J Surg 94(6):696–701

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Ashton HA, Buxton MJ, Day NE et al (2002) The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet 360(9345):1531–1539

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Kim LG, RA PS, Ashton HA, Thompson SG (2007) A sustained mortality benefit from screening for abdominal aortic aneurysm 2. Ann Intern Med146(10):699–706

    Google Scholar 

  16. 16.

    Norman PE, Jamrozik K, Lawrence-Brown MM et al (2004) Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm. BMJ 329(7477):1259

    PubMed  Article  Google Scholar 

  17. 17.

    Lindholt JS, Juul S, Fasting H, Henneberg EW (2005) Screening for abdominal aortic aneurysms: single centre randomised controlled trial. BMJ 330(7494):750

    PubMed  Article  Google Scholar 

  18. 18.

    Lindholt JS, Juul S, Henneberg EX (2007) High-risk and Low-risk Screening for Abdominal Aortic Aneurysm both reduce Aneurysm-related Mortality. A Stratified Analysis from a Single-centre Randomised Screening Trial. Eur J Vasc Endovasc Surg 34:53–58

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Lindholt JS, Juul S, Fasting H, Henneberg EW (2006) Preliminary ten years results from a randomised single centre mass screening trial for abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 32(6):608–614

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Scott RA, Bridgewater SG, Ashton HA (2002) Randomized clinical trial of screening for abdominal aortic aneurysm in women. Br J Surg 89(3):283–285

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Vardulaki KA, Walter NM, Couto E et al (2002) Late results concerning feasibility and compliance from a randomized trial of ultrasonographic screening for abdominal aortic aneurysm. Br J Surg 89(7):861–864

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Chichester Aneurysm Screening Group, Viborg Aneurysm Screening Study, Western Australian Abdominal Aortic Aneurysm Program, Multicentre Aneurysm Screening Study (2001) A comparative study of the prevalence of abdominal aortic aneurysms in the United Kingdom, Denmark, and Australia. J Med Screen 8(1):46–50

    Article  Google Scholar 

  23. 23.

    The United Kingdom small aneurysm trial participants (2002) Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 346(19):1445–1452

    Article  Google Scholar 

  24. 24.

    Lindholt JS, Norman P (2008) Screening for abdominal aortic aneurysm reduces overall mortality in men. A meta-analysis of the mid- and long-term effects of screening for abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 36(2):167–171

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    U.S. Preventive Services Task Force (2005) Screening for abdominal aortic aneurysm: recommendation statement. Ann Intern Med142:198–202

    Google Scholar 

  26. 26.

    U.S. Preventive Services Task Force (2009) http://www.ahrq.gov/clinic/pocketgd.htm. U.S. Preventive Services Task Force, Rockville, USA

  27. 27.

    Kent KC, Zwolak RM, Jaff MR et al (2004) Screening for abdominal aortic aneurysm: A consensus statement. J Vasc Surg 39:267–269

    PubMed  Article  Google Scholar 

  28. 28.

    Eckstein HH, Böckler D, Flessenkämper I et al (2009) Ultraschall-Screening abdomineller Aortenaneurysmen (AAA) Dtsch Ärztebl (angenommen zur Publikation)

  29. 29.

    Powell JT (2000) Abdominal aortic aneurysm: natural history and risk of rupture. In: Branchereau A, Jacobs M (eds) Surgical and endovascular treatment od aortic aneurysms. EVC, Futura Publishing, New York, pp 11–18

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Böckler, D., Lang, W., Debus, E. et al. Randomisierte Studien mit EBM-Level 1 beweisen es. Gefässchirurgie 14, 350–361 (2009). https://doi.org/10.1007/s00772-009-0696-y

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Schlüsselwörter

  • Abdominelle Aorta
  • Aneurysma
  • Screening
  • Ultraschall
  • Studie

Keywords

  • Abdominal aorta
  • Aneurysm
  • Screening
  • Ultrasound
  • Study