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Clinical risk indicators for formation of abdominal aortic aneurysms

English version

Klinische Risikoindikatoren für die Entstehung abdominaler Aortenaneurysmen



Evidence for ultrasound screening of abdominal aortic aneurysms (AAA) has been confirmed in several international studies. The efficiency could be increased by taking into account additional information about risk factors and secondary diagnoses to reduce the number of persons to be examined.

Material and methods

Population-based studies from 2000 to 2014 concerning AAA screening were analyzed under the aspect of clinical risk factors. All randomized controlled studies (RCT) for AAA screening and health technology assessment (HTA) reports about clinical risk indicators were analyzed. The following variables were looked for: age, gender, smoking, family history, cardiovascular disease, peripheral arterial occlusive disease (PAOD), hypertension, obesity, chronic obstructive pulmonary disease (COPD), hypercholesterolemia and diabetes mellitus. In addition, a short survey of rarely studied clinical variables is given.


For the following risk factors a positive correlation for the development of AAA was found: body mass index (BMI), increasing age, male gender, nicotine history and a positive family history for AAA. Coronary artery disease (CAD), COPD and PAOD as comorbidities represent a significantly increased prevalence of AAA. Uncertain results and insufficient research results exist for obesity, hypercholesterolemia, COPD, physical activity and nutrition. The risk factors diabetes mellitus, non-white skin color as well as feminine sex were associated with a decreased probability of AAA.


Many of the known risk factors for atherosclerosis are also associated with an increased prevalence of AAA; however, this is not always true. For example, female sex, diabetes mellitus and certain increases in fat metabolism are associated with a decreased prevalence. For female sex a differentiated approach should be recommended as a more sophisticated analysis is able to identify significant risk factors that need to be taken into account because women have a significantly increased risk of rupture and form a large proportion of the cases of rupture. A sophisticated algorithm for the identification of individuals who would benefit from individualized indications for aortic screening could reduce the number needed to screen per identified aortic aneurysm.


In consideration of evident clinical risk factors, further groups of patients could be defined which could particularly benefit from AAA screening. Under this aspect, population-based prospective studies are necessary.



Die Evidenz eines Ultraschallscreenings auf abdominale Aortenaneurysmata (AAA) ist in mehreren randomisierten Studien belegt worden. Die Effizienz eines Screenings könnte durch die Berücksichtigung klinischer Risikoindikatoren erhöht werden.

Material und Methoden

Analyse populationsbasierter Studien aus dem Zeitraum 2000 bis 2014 zum Screening des abdominalen Aortenaneurysmas (AAA) hinsichtlich klinischer Risikoindikatoren. Außerdem wurden alle RCTs zum AAA-Screening und Health-Technology-Assessment- (HTA-)Berichte hinsichtlich klinischer Risikoindikatoren analysiert. Folgende klinische Variablen wurden analysiert: Lebensalter, Geschlechtszugehörigkeit, Nikotinabusus, Familienanamnese, kardiovaskuläre Erkrankungen, periphere arterielle Verschlusskrankheit (PAVK), arterielle Hypertonie, Adipositas, chronisch-obstruktive Lungenerkrankung (COPD), Hyperlipoproteinämie und Diabetes mellitus. Darüber hinaus wird eine kurze Übersicht zu bisher wenig untersuchten klinischen Variablen gegeben.


Signifikante Risikofaktoren für die Entstehung eines AAA sind ein zunehmendes Lebensalter, männliches Geschlecht, Nikotinabusus und AAAs in der familiären Anamnese. Weitere mögliche Risikofaktoren sind: kardiovaskuläre Erkrankungen (insbesondere koronare Herzkrankheit), arterielle Hypertonie und das Vorliegen einer peripheren arteriellen Verschlusskrankheit. Unsichere und unzureichend untersuchte Risikofaktoren sind: Adipositas, Hyperlipoproteinämie, chronisch-obstruktive Lungenerkrankung, körperliche Aktivität und Ernährungsgewohnheiten. Folgende klinischen Variablen sind mit einer geringeren Wahrscheinlichkeit eines AAA assoziiert: weibliches Geschlecht, nicht weiße Hautfarbe und Diabetes mellitus.


Die Berücksichtigung evidenter klinischer Risikofaktoren könnte weitere Patientengruppen definieren, die in besonderem Maße von einem AAA-Screening profitieren könnten. Hierzu sind populationsbasierte prospektive Studien notwendig.

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Fig. 1


  1. 1.

    Davis M, Harris M, Earnshaw JJ (2013) Implementation of the National Health Service Abdominal Aortic Aneurysm Screening Program in England. J Vasc Surg 57(5):1440–1445

    PubMed  Article  Google Scholar 

  2. 2.

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

    Article  Google Scholar 

  3. 3.

    U.S. Preventive Services Task Force (2007) Screening for carotid artery stenosis: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 147:854–859

    Article  Google Scholar 

  4. 4.

    LeFevre ML (2014) Screening for abdominal aortic aneurysm: U.S. Preventive services task force recommendation statement. Ann Intern Med. doi:10.7326/M14-1204 (Epub ahead of print)

  5. 5.

    Takagi H, Goto SN, Matsui M et al (2010) A further meta-analysis of population-based screening for abdominal aortic aneurysm. J Vasc Surg 52:1103–1108

    PubMed  Article  Google Scholar 

  6. 6.

    Multicentre Aneurysm Screening Study Group (2002) Multicentre Aneurysm Screening Study (MASS): cost effectiveness analysis of screening for abdominal aortic aneurysms based on four year results from randomised controlled trial. BMJ 325:1135–1142

    Article  Google Scholar 

  7. 7.

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

    PubMed Central  PubMed  Article  Google Scholar 

  8. 8.

    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 329:1259–1265

    PubMed Central  PubMed  Article  Google Scholar 

  9. 9.

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

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    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

    PubMed  Article  Google Scholar 

  11. 11.

    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

    PubMed  Article  Google Scholar 

  12. 12.

    Golledge J, Muller J, Shephard N et al (2007) Association between osteopontin and human abdominal aortic aneurysm. Arterioscler Thromb Vasc Biol 27(3):655–660

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    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(41):1–118

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    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

    PubMed  Article  Google Scholar 

  15. 15.

    Svensjo S, Bjorck M, Wanhainen A (2013) Current prevalence of abdominal aortic aneurysm in 70-year-old women. Br J Surg 100:367–372

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Derubertis BG, Trocciola SM, Ryer EJ et al (2007) Abdominal aortic aneurysm in women: prevalence, risk factors, and implications for screening. J Vasc Surg 46:630–635

    PubMed  Article  Google Scholar 

  17. 17.

    Longo C, Upchurch GR Jr (2005) Abdominal aortic aneurysm screening: recommendations and controversies. Vasc Endovascular Surg 39:213–219

    PubMed  Article  Google Scholar 

  18. 18.

    Cronin O, Morris DR, Walker PJ, Golledge J (2013) The association of obesity with cardiovascular events in patients with peripheral artery disease. Atherosclerosis 228:316–323

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    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

    PubMed  Article  Google Scholar 

  20. 20.

    Monney P, Hayoz D, Tinguely F et al (2004) High prevalence of unsuspected abdominal aortic aneurysms in patients hospitalised for surgical coronary revascularisation. Eur J Cardiothorac Surg 25:65–68

    PubMed  Article  Google Scholar 

  21. 21.

    Dall’Olmo C, Ippolito A, McIlduff J et al (2007) EPics I study: evaluation of possible abdominal aortic aneurysms (in patients who have undergone previous CABG). Vasc Dis Manag 4:1–6

    Google Scholar 

  22. 22.

    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

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    Hansen WH, Behrenbeck T, Spittell PC et al (2005) Biphasic Doppler pattern of the descending thoracic aorta: a new echocardiographic finding in patients with aortic valve stenosis. J Am Soc Echocardiogr 18(8):860–864

    PubMed  Article  Google Scholar 

  24. 24.

    Dijos M, Pucheux Y, Lafitte M et al (2012) Fast track echo of abdominal aortic aneurysm using a real pocket-ultrasound device at bedside. Echocardiography 29(3):285–290

    PubMed  Article  Google Scholar 

  25. 25.

    Bekkers SC, Borghans RA, Cheriex EC (2006) Ventricular pseudoaneurysm after subacute myocardial infarction. Int J Cardiovasc Imaging 22(6):791–795. doi:10.1007/s10554-006-9100-0

    PubMed  Article  Google Scholar 

  26. 26.

    Debus ED, Torsello G, Lang W et al (2014) Zur Behandlung des abdominellen Aortenaneurysmas in Deutschland – Qualitätssicherungsdaten 2013. Gefaesschirurgie (in print)

  27. 27.

    Flessenkamper I, Kendzia A, Stalke J (2009) Multizentrisches Screening eines arteriell vorerkrankten Patientenkollektivs in Hinblick auf die Prävalenz infrarenaler Aortenaneurysmen. BARE – Berliner Aneurysma Raten Evaluation. Gefaesschirurgie 14:376–383

    Article  Google Scholar 

  28. 28.

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

    CAS  PubMed  Article  Google Scholar 

  29. 29.

    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

    PubMed  Article  Google Scholar 

  30. 30.

    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

    PubMed  Article  Google Scholar 

  31. 31.

    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

    CAS  PubMed  Article  Google Scholar 

  32. 32.

    Mofidi R, Goldie VJ, Kelman J et al (2007) Influence of sex on expansion rate of abdominal aortic aneurysms. Br J Surg 94(3):310–314

    CAS  PubMed  Article  Google Scholar 

  33. 33.

    Norman PE, Powell JT (2007) Abdominal aortic aneurysm: the prognosis in women is worse than in men. Circulation 115(22):2865–2869

    CAS  PubMed  Article  Google Scholar 

  34. 34.

    Kung HC, Hoyert DL, Xu J, Murphy SL (2008) Deaths: final data for 2005. Natl Vital Stat Rep 56:1–120

    PubMed  Google Scholar 

  35. 35.

    Mureebe L, Egorova N, Giacovelli JK et al (2008) National trends in the repair of ruptured abdominal aortic aneurysms. J Vasc Surg 48:1101–1107

    PubMed  Article  Google Scholar 

  36. 36.

    Wanhainen A, Lundkvist J, Bergqvist D, Bjorck M (2006) Cost-effectiveness of screening women for abdominal aortic aneurysm. J Vasc Surg 43(5):908–914 (discussion 914)

    PubMed  Article  Google Scholar 

  37. 37.

    Harthun NL (2008) Current issues in the treatment of women with abdominal aortic aneurysm. Gend Med 5(1):36–43

    PubMed  Article  Google Scholar 

  38. 38.

    Abramson BL, Huckell V, Anand S et al (2005) Canadian Cardiovascular Society Consensus Conference: peripheral arterial disease – executive summary. Can J Cardiol 21(12):997–1006

    PubMed  Google Scholar 

  39. 39.

    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(4 Suppl):S2–S49

    PubMed  Article  Google Scholar 

  40. 40.

    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(6):1268–1276

    PubMed  Article  Google Scholar 

  41. 41.

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

    Google Scholar 

  42. 42.

    Fowkes FG, Anandan CL, Lee AJ et al (2006) Reduced lung function in patients with abdominal aortic aneurysm is associated with activation of inflammation and hemostasis, not smoking or cardiovascular disease. J Vasc Surg 43:474–480

    PubMed  Article  Google Scholar 

  43. 43.

    Laarhoven CJ van, Borstlap AC, Berge Henegouwen DP van et al (1993) Chronic obstructive pulmonary disease and abdominal aortic aneurysms. Eur J Vasc Surg 7:386–390

    PubMed  Article  Google Scholar 

  44. 44.

    Ceniga MV de, Blanoc-Colio LM, Tunon J (2013) Statin use in aortic aneurismal disease to prevent progression and cardiovascular events: review of experimental and clinical data. Curr Vasc Pharmacol 11:299–304

    PubMed  Article  Google Scholar 

  45. 45.

    Takagi H, Manabe H, Kawai N et al (2010) Serum high-density and low-density lipoprotein cholesterol is associated with abdominal aortic aneurysm presence: a systematic review and meta-analysis. Int Angiol 29:371–375

    CAS  PubMed  Google Scholar 

  46. 46.

    Takagi H, Manabe H, Kawai N et al (2009) Circulating lipoprotein(a) concentrations and abdominal aortic aneurysm presence. Interact Cardiovasc Thorac Surg 9:467–470

    PubMed  Article  Google Scholar 

  47. 47.

    NHS (no year given) NHS screening programme for abdominal aortic aneurysm 2011. Accessed: 11 Aug 2011

  48. 48.

    Agency for Healthcare Research and Quality (no year given) Talk with your health care provider about screening for abdominal aortic aneurysm. Accessed: 9 July 2014

  49. 49.

    Hirsch AT, Haskal ZJ, Hertzer NR et al (2006) ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 113(11):e463–e654

    PubMed  Article  Google Scholar 

  50. 50.

    Kent KC, Zwolak RM, Jaff MR et al (2004) Screening for abdominal aortic aneurysm: a consensus statement. J Vasc Surg 39(1):267–269

    PubMed  Article  Google Scholar 

  51. 51.

    Stather PW, Dattani N, Bown MJ et al (2013) International variations in AAA screening. Eur J Vasc Endovasc Surg 45(3):231–234

    CAS  PubMed  Article  Google Scholar 

  52. 52.

    HTA Core Model Online (no year given) Abdominal aorta aneurysm screening.

  53. 53.

    UK National Screening Committee (2007) NHS abdominal aortic aneurysm screening.

  54. 54.

    Lederle FA, Johnson GR, Wilson SE et al (2000) 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 160(10):1425–1430

    CAS  PubMed  Article  Google Scholar 

  55. 55.

    Singh K, Bønaa KH, Jacobsen BK et al (2001) Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study: the Tromsø Study. Am J Epidemiol 154:236–244

    CAS  PubMed  Article  Google Scholar 

  56. 56.

    Forsdahl SH, Singh K, Solberg S, Jacobsen BK (2009) Risk factors for abdominal aortic aneurysms: a 7-year prospective study: the Tromsø Study, 1994–2001. Circulation 119(16):2202–2208. doi:10.1161/CIRCULATIONAHA.108.817619. (Epub 2009 Apr 13)

    PubMed  Article  Google Scholar 

  57. 57.

    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(1):87–92. doi:10.1016/j.avsg.2013.06.016. (Epub 2013 Nov 1)

    PubMed  Article  Google Scholar 

  58. 58.

    Pleumeekers HJ, Hoes AW, Does E van der et al (1995) Aneurysms of the abdominal aorta in older adults. The Rotterdam Study. Am J Epidemiol 142(12):1291–1299

    CAS  PubMed  Google Scholar 

  59. 59.

    Health Quality Ontario (2006) Ultrasound screening for abdominal aortic aneurysm: an evidence-based analysis. Ont Health Technol Assess Ser 6(2):1–67 (Epub 2006 Jan 1)

    Google Scholar 

  60. 60.

    Health Quality Ontario (2009) Fenestrated endovascular grafts for the repair of juxtarenal aortic aneurysms: an evidence-based analysis. Ont Health Technol Assess Ser 9(4):1–51. (Epub 2009 Jul 1)

    Google Scholar 

  61. 61.

    Solberg S, Singh K, Wilsgaard T, Jacobsen BK (2005) Increased growth rate of abdominal aortic aneurysms in women. The Tromsø study. Eur J Vasc Endovasc Surg 29(2):145–149

    CAS  PubMed  Article  Google Scholar 

  62. 62.

    De Rango P, Farchioni L, Fiorucci B, Lenti M (2014) Diabetes and abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 47(3):243–261. doi:10.1016/j.ejvs.2013.12.007. (Epub 2014 Jan 18 Review)

    Article  Google Scholar 

  63. 63.

    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)

    PubMed  Article  Google Scholar 

  64. 64.

    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

    CAS  PubMed  Article  Google Scholar 

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Compliance with ethical guidelines

Conflict of interest. I. Flessenkämper, H. Söllner, and H.-H. Eckstein declare that there are no conflicts of interest. This paper does not include any studies on humans or animals.

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Correspondence to I. Flessenkämper.

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The German version of this article is published in Gefässchirurgie (2014) 19:549–557.

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Flessenkämper, I., Söllner, H. & Eckstein, HH. Clinical risk indicators for formation of abdominal aortic aneurysms. Gefässchirurgie 20, 13–21 (2015).

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  • Abdominal aortic aneurysm
  • Screening
  • Risk factors
  • Comorbidity
  • Population based


  • Abdominales Aortenaneurysma
  • Screening
  • Risikofaktoren
  • Nebenerkrankungen
  • Populationsbasiert