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Ultraschallscreening auf abdominale Aortenaneurysmen (AAA)

Evidenz aus randomisierten Studien

Ultrasound screening for abdominal aortic aneurysms

Evidence from randomized controlled trials

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Zusammenfassung

Hintergrund

Die Ruptur eines abdominalen Aortenaneurysmas (AAA) ist mit einer hohen Letalität assoziiert. Die rechtzeitige Diagnose und elektive Operation eines rupturgefährdeten AAA stellt die einzig mögliche präventive Therapie dar. Mittels einer B-Bild-Sonographie können AAAs mit hoher Zuverlässigkeit frühzeitig erkannt werden. Ein populationsbasiertes Ultraschallscreening könnte das Risiko einer AAA-Ruptur verringern.

Material und Methoden

Es erfolgte eine Literaturanalyse (bis Juni 2014, MEDLINE, PubMed, SCOPUS) aller randomisiert-kontrollierten Studien (RCT), sowie systematischen Reviews, Metaanalysen, Health Technology Assessments (HTA-Berichte) und Leitlinien zum AAA-Screening. Stichworte waren: „abdominal aortic aneurysm“, „ultrasound screening“, „evidence“ und „guidelines“. Als relevante Endpunkte galten: AAA-bedingte Letalität, Gesamtletalität, Anzahl elektiver AAA-Operationen, Anzahl rupturierter AAAs und Notfalloperationen für verschiedene Untersuchungsintervalle.

Ergebnisse

In vier RCTs erfolgte bei 65 bis 83-jährigen Männern entweder eine einmalige Ultraschalluntersuchung der abdominalen Aorta oder keine Untersuchung. Ältere Frauen wurden nur in einem RCT untersucht. Die Metaanalyse der Ergebnisse zeigt, dass das Ultraschallscreening zu einer signifikanten Abnahme der AAA-bedingten Letalität, der Anzahl rupturierter abdominaler AAAs und der Anzahl notfallmäßiger AAA-Operationen führt. Die Anzahl der elektiven AAA-Operationen nimmt signifikant zu. Die Gesamtletalität wird durch das AAA-Screening nur gering verringert.

Schlussfolgerungen

Die Effizienz eines ultraschallbasierten AAA-Screenings > 65-jähriger Männer ist in populationsbasierten RCTs und nachfolgenden Metaanalysen sehr gut belegt. Derzeit wird seitens des Gemeinsamen Bundesauschusses (G-BA) und des Instituts für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWIG) ein nationales AAA-Ultraschallscreening-Programm für Deutschland evaluiert. Weitere Studien sind notwendig, um Risikogruppen zu erfassen, die in den bisherigen Studien unterrepräsentiert waren. Hierzu gehören Männer unter 65 Jahren und Frauen mit Niktotinabusus und/oder kardiovaskulären Begleiterkrankungen.

Abstract

Background

Abdominal aortic aneurysm (AAA) rupture is associated with a high mortality. The only preventive therapy is early diagnosis and elective surgery of rupture prone AAAs. Using B-mode sonography AAAs can be detected early with great reliability. Thus, a population-based ultrasound screening might lower the risk of abdominal aortic aneurysm ruptures.

Materials and methods

A literature analysis (until June 2014) was performed in the databases of MEDLINE, PubMed, and SCOPUS including all randomized controlled trials (RCT), systematic reviews, meta-analyses, health technology assessments (HTA reports) and medical guidelines on AAA screening. The following keywords were used: abdominal aortic aneurysm, ultrasound screening, evidence, guidelines. Clinically relevant endpoints were the following: AAA-associated mortality, overall mortality, number of elective AAA operations, number of ruptured AAAs and emergency surgery for different follow-up intervals.

Results

In four RCTs men between 65 and 83 years either had a single or no ultrasound examination of the abdominal aorta. Older women were only analyzed in one RCT. The meta-analysis of the RCT results shows that ultrasound screening caused a significant decrease of AAA-associated mortality, number of ruptured abdominal aneurysms, and number of emergency operations, whereas the number of elective surgeries significantly increased. Overall mortality was only moderately decreased by AAA screening.

Conclusion

Evidence was provided in population-based RCTs and meta-analyses for the efficiency of ultrasound based AAA screening for men older than 65 years. Presently the Federal Joint Committee (G-BA) and the Institute for Quality and Efficiency in Health Care (IQWIG) are evaluating a national ultrasound-based AAA screening program for Germany. However, additional clinical trials are necessary to assess risk groups especially men under 65 years, women with nicotine abuse and cardiovascular diseases which were underrepresented in previous studies.

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Literatur

  1. Abramson BL, Huckell V, Anand S et al (2005) Canadian Cardiovascular Society Consensus Conference: peripheral arterial disease – executive summary. Can J Cardiol 21:997–1006

    PubMed  Google Scholar 

  2. HTA Core Model Online (2013) Abdominal Aorta Aneurysm Screening. http://meka.thl.fi/htacore/ViewCover.aspx?id=106

  3. U.S. Preventive Task Force (2005) Screening for abdominal aortic aneurysm: recommendation statement. Ann Intern Med 142:198–202

    Article  Google Scholar 

  4. Statistisches Bundesamt, Wiesbaden (2014) Tiefgegliederte und 5-stellige Diagnose-daten der Krankenhauspatientinnen und -patienten. http://www.destatis.de

  5. 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 360:1531–1539

    Article  PubMed  CAS  Google Scholar 

  6. 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. Br J Surg 94:696–701

    Article  PubMed  CAS  Google Scholar 

  7. Beales L, Wolstenhulme S, Evans JA et al (2011) Reproducibility of ultrasound measurement of the abdominal aorta. Br J Surg 98:1517–1525

    Article  PubMed  CAS  Google Scholar 

  8. Bonnafy T, Lacroix P, Desormais I et al (2013) Reliability of the measurement of the abdominal aortic diameter by novice operators using a pocket-sized ultrasound system. Arch Cardiovasc Dis 106:644–650

    Article  PubMed  Google Scholar 

  9. Brewster DC, Cronenwett JL, Hallett JW Jr et al (2003) Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg 37:1106–1117

    Article  PubMed  Google Scholar 

  10. Chaikof EL, Brewster DC, Dalman RL et al (2009) The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 50:S2–S49

    Article  PubMed  Google Scholar 

  11. Chun KC, Teng KY, Chavez LA et al (2014) Risk factors associated with the diagnosis of abdominal aortic aneurysm in patients screened at a regional Veterans Affairs health care system. Ann Vasc Surg 28:87–92

    Article  PubMed  Google Scholar 

  12. Cosford PA, Leng GC (2007) Screening for abdominal aortic aneurysm. Cochrane Database Syst Rev 18(2):CD002945

    Google Scholar 

  13. Durieux R, Van Damme H, Labropoulos N et al (2014) High prevalence of abdominal aortic aneurysm in patients with three-vessel coronary artery disease. Eur J Vasc Endovasc Surg 47:273–278

    Article  PubMed  CAS  Google Scholar 

  14. Eckstein HH, Bockler D, Flessenkamper I et al (2009) Ultrasonographic screening for the detection of abdominal aortic aneurysms. Dtsch Arztebl Int 106:657–663

    PubMed  PubMed Central  Google Scholar 

  15. Ferket BS, Grootenboer N, Colkesen EB et al (2012) Systematic review of guidelines on abdominal aortic aneurysm screening. J Vasc Surg 55:1296–1304

    Article  PubMed  Google Scholar 

  16. Flessenkämper I, Kendzia A, Stalke J (2009) Multizentrisches Screening eines arteriell vorerkrankten Patientenkollektivs in Hinblick auf die Prävalenz infrarenaler Aortenaneurysmen. Gefässchirurgie 14:376–383

    Article  Google Scholar 

  17. Guirguis-Blake JM, Beil TL, Sun X et al (2014) Primary care screening for abdominal aortic aneurysm: an evidence update for the U.S. Preventive Services Task Force. Evidence Synthesis No. 109. Agency for Healthcare Research and Quality, Rockville, S 1–153

  18. Hartshorne TC, Mccollum CN, Earnshaw JJ et al (2011) Ultrasound measurement of aortic diameter in a national screening programme. Eur J Vasc Endovasc Surg 42:195–199

    Article  PubMed  CAS  Google Scholar 

  19. Kent KC, Zwolak RM, Egorova NN et al (2010) Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg 52:539–548

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  21. Kim LG, Thompson SG, Briggs AH et al (2007) How cost-effective is screening for abdominal aortic aneurysms? J Med Screen 14:46–52

    Article  PubMed  CAS  Google Scholar 

  22. Lawrence-Brown MM, Norman PE, Jamrozik K et al (2001) Initial results of ultrasound screening for aneurysm of the abdominal aorta in Western Australia: relevance for endoluminal treatment of aneurysm disease. Cardiovasc Surg 9:234–240

    Article  PubMed  CAS  Google Scholar 

  23. Lefevre ML (2014) Screening for abdominal aortic aneurysm: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med

  24. Lindholt JS (2007) Relatively high pulmonary and cardiovascular mortality rates in screening-detected aneurysmal patients without previous hospital admissions. Eur J Vasc Endovasc Surg 33:94–99

    Article  PubMed  CAS  Google Scholar 

  25. Lindholt JS, Juul S, Fasting H et al (2006) Cost-effectiveness analysis of screening for abdominal aortic aneurysms based on five year results from a randomised hospital based mass screening trial. Eur J Vasc Endovasc Surg 32:9–15

    Article  PubMed  CAS  Google Scholar 

  26. Lindholt JS, Juul S, Fasting H et al (2002) Hospital costs and benefits of screening for abdominal aortic aneurysms. Results from a randomised population screening trial. Eur J Vasc Endovasc Surg 23:55–60

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  28. Lindholt JS, Juul S, Henneberg EW (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

    Article  PubMed  CAS  Google Scholar 

  29. 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 36:167–171

    Article  PubMed  CAS  Google Scholar 

  30. Lindholt JS, Sorensen J, Sogaard R et al (2010) Long-term benefit and cost-effectiveness analysis of screening for abdominal aortic aneurysms from a randomized controlled trial. Br J Surg 97:826–834

    Article  PubMed  CAS  Google Scholar 

  31. 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 17:472–475

    Article  PubMed  CAS  Google Scholar 

  32. Linne A, Lindstrom D, Hultgren R (2012) High prevalence of abdominal aortic aneurysms in brothers and sisters of patients despite a low prevalence in the population. J Vasc Surg 56:305–310

    Article  PubMed  Google Scholar 

  33. Long A, Bui HT, Barbe C et al (2010) Prevalence of abdominal aortic aneurysm and large infrarenal aorta in patients with acute coronary syndrome and proven coronary stenosis: a prospective monocenter study. Ann Vasc Surg 24:602–608

    Article  PubMed  Google Scholar 

  34. Mastracci TM, Cina CS (2007) Screening for abdominal aortic aneurysm in Canada: review and position statement of the Canadian Society for Vascular Surgery. J Vasc Surg 45:1268–1276

    Article  PubMed  Google Scholar 

  35. Moll FL, Powell JT, Fraedrich G et al (2011) Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg 41(Suppl 1):S1–S58

    Article  PubMed  Google Scholar 

  36. 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 329:1259

    Article  PubMed  PubMed Central  Google Scholar 

  37. Sakalihasan N, Defraigne JO, Kerstenne MA et al (2014) Family members of patients with abdominal aortic aneurysms are at increased risk for aneurysms: analysis of 618 probands and their families from the Liege AAA Family Study. Ann Vasc Surg 28:787–797

    Article  PubMed  Google Scholar 

  38. Sakalihasan N, Limet R, Defawe OD (2005) Abdominal aortic aneurysm. Lancet 365:1577–1589

    Article  PubMed  CAS  Google Scholar 

  39. Salo JA, Soisalon-Soininen S, Bondestam S et al (1999) Familial occurrence of abdominal aortic aneurysm. Ann Intern Med 130:637–642

    Article  PubMed  CAS  Google Scholar 

  40. Scott RA, Tisi PV, Ashton HA et al (1998) Abdominal aortic aneurysm rupture rates: a 7-year follow-up of the entire abdominal aortic aneurysm population detected by screening. J Vasc Surg 28:124–128

    Article  PubMed  CAS  Google Scholar 

  41. Scott RA, Vardulaki KA, Walker NM et al (2001) The long-term benefits of a single scan for abdominal aortic aneurysm (AAA) at age 65. Eur J Vasc Endovasc Surg 21:535–540

    Article  PubMed  CAS  Google Scholar 

  42. Scott RAP, Bridgewater SG, Ashton HA (2002) RCT of screening for AAA in women. Br J Surg 89:283–285

    Article  PubMed  CAS  Google Scholar 

  43. Scott RAP (2002) The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet 360:1531–1539

    Article  PubMed  Google Scholar 

  44. Stather PW, Dattani N, Bown MJ et al (2013) International variations in AAA screening. Eur J Vasc Endovasc Surg 45:231–234

    Article  PubMed  CAS  Google Scholar 

  45. Thompson SG, Ashton HA, Gao L et al (2012) Final follow-up of the Multicentre Aneurysm Screening Study (MASS) randomized trial of abdominal aortic aneurysm screening. Br J Surg 99:1649–1656

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  46. Thompson SG, Ashton HA, Gao L et al (2009) Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. BMJ 338:b2307

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  47. Thompson SG, Brown LC, Sweeting MJ et al (2013) Systematic review and meta-analysis of the growth and rupture rates of small abdominal aortic aneurysms: implications for surveillance intervals and their cost-effectiveness. Health Technol Assess 17:1–118

    Article  PubMed  CAS  Google Scholar 

  48. Vardulaki KA, Walker NM, Day NE et al (2000) Quantifying the risks of hypertension, age, sex and smoking in patients with abdominal aortic aneurysm. Br J Surg 87:195–200

    Article  PubMed  CAS  Google Scholar 

  49. Wong DR, Willett WC, Rimm EB (2007) Smoking, hypertension, alcohol consumption, and risk of abdominal aortic aneurysm in men. Am J Epidemiol 165:838–845

    Article  PubMed  Google Scholar 

  50. Antoniou GA, Giannoukas AD, Georgiadis GS et al (2011) Increased prevalence of abdominal aortic aneurysm in patients undergoing inguinal hernia repair compared with patients without hernia receiving aneurysm screening. J Vasc Surg 53(5):1184–1188. doi:10.1016/j.jvs.2010.11.053 (Epub 2011 Jan 13)

    Article  PubMed  Google Scholar 

  51. Henriksen NA, Sorensen LT, Jorgensen LN, Lindholt JS (2013) Lack of association between inguinal hernia and abdominal aortic aneurysm in a population-based male cohort. Br J Surg 100(11):1478–1482. doi:10.1002/bjs.9257

    Article  PubMed  CAS  Google Scholar 

  52. Trenner M, Haller B, Sollner H et al (2013) Twelve years of the quality assurance registry abdominal aortic aneurysm of the German Vascular Society (DGG). Part 1: trends in therapy and outcome of non-ruptured abdominal aortic aneurysms in Germany between 1999 and 2010. GEFASSCHIRURGIE 18(3):206–213. doi:10.1007/s00772-013-1159-z

    Google Scholar 

  53. Wild JB, Stather PW, Biancari F et al (2013) A multicentre observational study of the outcomes of screening detected sub-aneurysmal aortic dilatation. Eur J Vasc Endovasc Surg 45(2):128–134. doi:10.1016/j.ejvs.2012.11.024 (Epub 2012 Dec 28)

    Article  PubMed  CAS  Google Scholar 

  54. Anjum A, Powell JT (2012) Is the incidence of abdominal aortic aneurysm declining in the 21st century? Mortality and hospital admissions for England & Wales and Scotland. Eur J Vasc Endovasc Surg 43(2):161–6. doi:10.1016/j.ejvs.2011.11.014 (Epub 2011 Dec 16)

    Article  PubMed  CAS  Google Scholar 

  55. Norman PE, Spilsbury K, Semmens JB (2011) Falling rates of hospitalization and mortality from abdominal aortic aneurysms in Australia. J Vasc Surg 53(2):274–277. doi:10.1016/j.jvs.2010.08.087 (Epub 2010 Nov 4)

    Article  PubMed  Google Scholar 

  56. Sandiford P, Mosquera D, Bramley D (2012) Ethnic inequalities in incidence, survival and mortality from abdominal aortic aneurysm in New Zealand. J Epidemiol Community Health 66(12):1097–1103. doi:10.1136/jech-2011-200754 (Epub 2012 Jul 5)

    Article  PubMed  Google Scholar 

  57. Wanhainen A, Bylund N, Björck M (2008) Outcome after abdominal aortic aneurysm repair in Sweden 1994–2005. Br J Surg 95(5):564–570. doi:10.1002/bjs.6109

    Article  PubMed  CAS  Google Scholar 

  58. Earnshaw J (2014) The National Health Service Abdominal Aortic Aneurysm Screening Programme in England: implementation and optimisation. Gefässchirurgie 6 (Beitrag im aktuellen Heft bitte Daten wie Seitenzahlen etc. ergänzen)

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Interessenkonflikt. H.-H. Eckstein, C. Reeps, A. Zimmermann und H. Söllner geben an, dass kein Interessenkonflikt besteht.

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  1. Klinik für Vaskuläre und Endovaskuläre Chirurgie und Münchener Aorten Centrum (MAC), Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 21, 81675, München, Deutschland

    H.-H. Eckstein, C. Reeps, A. Zimmermann & H. Söllner

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  1. H.-H. Eckstein
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Eckstein, HH., Reeps, C., Zimmermann, A. et al. Ultraschallscreening auf abdominale Aortenaneurysmen (AAA). Gefässchirurgie 19, 515–527 (2014). https://doi.org/10.1007/s00772-014-1324-z

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