Search

Background: Sweden and the UK invite all 65-year-old men to a population-based ultrasound-based screening program to detect abdominal aortic aneurysms (AAA). First-degree relatives of patients with AAA are reported to have an increased risk to develop AAA, both women and men, but are not invited to screening. The "Detecting AAA in First Degree Relatives to AAA patients" (DAAAD) was designed to detect the true prevalence in adult offspring to AAA patients and to evaluate if national registries could be used for identification of index persons and their adult children with a high risk for the disease. The aim of this study is to summarize the design and methodology for this registry-based study. Methods: The study is based on a registry-based extraction and identification of a risk group in the population with a subsequent identification of their adult offspring. The targeted risk group suffers a heredity for a potentially lethal disease, AAA (n = 750) and matched control group without heredity for AAA is also identified and invited (n = 750). The participation rate in the population-based AAA screening program for men is 75% regionally. This population is younger and have a lower prevalence. A participation rate of 65% is considered clinically adequate. For the DAAAD study, a stratified analysis of the primary outcome, prevalence, will be performed for women and men separately. Two other planned projects are based on the material: firstly, evaluation of the anxiety for disease and health-related quality of life (HRQoL) and, secondly, the cost-effectiveness of the study. Discussion: In conclusion, this feasibility study will be instrumental in supporting the development of a possible new model to invite persons with high risk to develop hereditary rare diseases. To our knowledge, this is a unique, safe, and most likely to be a cost-efficient model to invite targeted risk groups for selected screening. If the study design and the results are shown to be cost-effective at the detected participation rate and prevalence, it should be further evaluated and adopted to a national screening program. The model also invites both women and men, which is unique for this specific patient group, considering that all population-based screening programs only include men. Trial registration: This trial is registered at the website of Clinical Trials. ClinicalTrials.gov identifier, NCT4623268 [ABSTRACT FROM AUTHOR]

Background: Robust risk-adjusted analyses have demonstrated that a reduction in perioperative mortality is associated with the repair of an abdominal aortic aneurysm (AAA) in centres with a high operative caseload (volume). However, the long-term impact of this volume-related effect on mortality remains unknown. Methods: Demographic and clinical data were extracted from UK Hospital Episodes Statistics for patients undergoing elective repair of an infrarenal AAA from 1 April 2000 to 31 March 2005. The long-term mortality of this cohort was investigated through linkage to the UK Office for National Statistics (ONS) registry. Risk-adjusted survival was analysed using Cox proportional hazards modelling to identify the effect of hospital volume on long-term mortality. Results: A total of 14 396 patients with mean age of 72 years, of whom 85·7 per cent were men, underwent elective repair of an infrarenal AAA in England. They were linked to follow-up using ONS data. Risk-adjusted analysis of all-cause mortality by Cox proportional hazards modelling demonstrated a significant effect of hospital volume across all quintiles up to 2 years ( P = 0·013). Remodelling the data after excluding in-hospital mortality still demonstrated the significant effect of hospital volume on late outcome. Conclusion: There is a long-term benefit to patients who undergo elective AAA repair in a high-volume hospital. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Few data are available on the long-term outcome of endovascular repair of abdominal aortic aneurysm as compared with open repair. Methods: From 1999 through 2004 at 37 hospitals in the United Kingdom, we randomly assigned 1252 patients with large abdominal aortic aneurysms (≥5.5 cm in diameter) to undergo either endovascular or open repair; 626 patients were assigned to each group. Patients were followed for rates of death, graft-related complications, reinterventions, and resource use until the end of 2009. Logistic regression and Cox regression were used to compare outcomes in the two groups. Results: The 30-day operative mortality was 1.8% in the endovascular-repair group and 4.3% in the open-repair group (adjusted odds ratio for endovascular repair as compared with open repair, 0.39; 95% confidence interval [CI], 0.18 to 0.87; P=0.02). The endovascular-repair group had an early benefit with respect to aneurysm-related mortality, but the benefit was lost by the end of the study, at least partially because of fatal endograft ruptures (adjusted hazard ratio, 0.92; 95% CI, 0.57 to 1.49; P=0.73). By the end of follow-up, there was no significant difference between the two groups in the rate of death from any cause (adjusted hazard ratio, 1.03; 95% CI, 0.86 to 1.23; P=0.72). The rates of graft-related complications and reinterventions were higher with endovascular repair, and new complications occurred up to 8 years after randomization, contributing to higher overall costs. Conclusions: In this large, randomized trial, endovascular repair of abdominal aortic aneurysm was associated with a significantly lower operative mortality than open surgical repair. However, no differences were seen in total mortality or aneurysm-related mortality in the long term. Endovascular repair was associated with increased rates of graft-related complications and reinterventions and was more costly. (Current Controlled Trials number, ISRCTN55703451.) N Engl J Med 2010;362:1863-71. [ABSTRACT FROM AUTHOR]

Background: Vascular Biochemistry and Haematology Outcome Models (VBHOM) adopted the approach of using a minimum data set to model outcome. This study aimed to test such a model on a cohort of patients undergoing open elective and non-elective abdominal aortic aneurysm (AAA) repair. Methods: A binary logistic regression model of risk of in-hospital mortality was built from the 2002-2004 submission to the UK National Vascular Database (NVD) (2718 patients). The subset of NVD data items used comprised serum levels of urea, sodium and potassium, haemoglobin, white cell count, sex, age and mode of admission. The model was applied prospectively using Hosmer-Lemeshow methodology to a test data set from the Cambridge Vascular Unit. Results: The validation set contained 327 patients, of whom 208 had elective AAA repair and 119 had emergency repair of a ruptured AAA. Outcome following elective and non-elective AAA repair could be described accurately using the same model. The overall mean predicted risk of death was 14.13 per cent, and 48 deaths were predicted. The actual number of deaths was 53 (X² = 8.40, 10 d.f., P = 0.590; no evidence of lack of fit). The model also demonstrated good discrimination (c-index = 0.852). Conclusion: The VBHOM approach has the advantage of using simple, objective clinical data that are easy to collect routinely. The VBHOM data items potentially allow prediction of risk in an individual patient before aneurysm surgery. [ABSTRACT FROM AUTHOR]

Background: The aim was to use a validated fitness score to determine whether fitter patients with a large abdominal aortic aneurysm (AAA) benefited from having open rather than endovascular repair. Methods: The Customized Probability Index (CPI) was applied to patients in the Endovascular Aneurysm Repair (EVAR) I and II trials. Interaction tests between CPI and randomized group assessed the effect of fitness and type of AAA repair on elective 30-day mortality and 4-year survival. Results: The mean(s.d.) CPI scores were 3.6(9.3) for 1252 EVAR I patients and 10.0(11.3) for 404 EVAR II patients (range -25 to +43) (P < 0-001). The fitness of EVAR I patients was classified as good (579 patients, mean CPI -4.2), moderate (331 patients, mean CPI 5.7) or poor (338 patients, mean CPI 15.1). Only in the good fitness group did 30-day mortality convincingly favour endovascular repair (odds ratio 0.24, P = 0.030), but overall the test of interaction was not significant (P = 0.363). For 4-year all-cause and aneurysm-related mortality, there was no benefit for either treatment across all fitness scores (P = 0.281 and P = 0.371 respectively). Conclusion: The benefit of endovascular repair was most convincing in the fittest patients. There was no evidence that the fittest patients benefited more from open surgery. [ABSTRACT FROM AUTHOR]

Background: The aim was to determine whether early open surgical repair would benefit patients with small abdominal aortic aneurysm compared with surveillance on long-term follow-up. Methods: The 1090 patients who were enrolled into the UK Small Aneurysm Trial between 1991 and 1995 were followed up for aneurysm repair and mortality until November 2005. Results: By November 2005, 714 patients (65.5 per cent) had died, 929 (85.2 per cent) had undergone aneurysm repair, 150 (13.8 per cent) had died without aneurysm repair and 11 (1.0 per cent) remained alive without aneurysm repair. After 12 years, mortality in the surgery and surveillance groups was 63.9 and 67.3 percent respectively, unadjusted hazard ratio 0.90 (P = 0.139). Three-quarters of the surveillance group eventually had aneurysm repair, with a 30-day elective mortality of 6.3 per cent (versus 5.0 per cent in the early surgery group, P = 0.366). Estimates suggested that the cost of treatment was 17 per cent higher in the early surgery group, with a mean difference of £1326. The death rate in these patients was about twice that in the population matched for age and sex. Conclusion: There was no long-term survival benefit of early elective open repair of small abdominal aortic aneurysms. Even after successful aneurysm repair, the mortality among these patients was higher than in the general population. [ABSTRACT FROM AUTHOR]

Background: The aim was to assess the relationship between hospital volume and outcome after abdominal aortic aneurysm (AAA) surgery in the UK. Methods: Hospital Episode Statistics (2000-2005) were classified as elective, urgent or ruptured AAA repair. Analysis was by modelling of mortality rate, complication rate and length of hospital stay with regard to the annual operative volume, after risk adjustment. Results: There were 112 545 diagnoses, or repairs, of AAAs, of which 26 822 were infrarenal aneurysms. The mean mortality rate was 7.4, 23.6 and 41-8 per cent for elective, urgent and ruptured AAA repair respectively. Elective AAA repair undertaken at high-volume hospitals showed volume-related improvements in mortality (P < 0.001). Patients were discharged from hospital earlier (P < 0.001). The critical volume threshold was 32 elective AAA repairs per year. For urgent repair, patients at high-volume hospitals had a reduced mortality rate (P = 0.017) with an increased length of stay (P = 0.041). There was no relationship between volume and outcome for ruptured AAA repairs. Conclusion: Increased annual volumes were associated with significant reductions in mortality for elective and urgent AAA repair, but not for repair of ruptured AAAs. [ABSTRACT FROM AUTHOR]

Background: This study investigated the volume-outcome relationship for abdominal aortic aneurysm (AAA) surgery and quantified critical volume thresholds. Methods: PubMed, EMBASE and the Cochrane library were searched for articles on the operation volume-outcome relationship in elective and ruptured AAA surgery. UK Hospital Episode Statistics data were also considered. Elective and ruptured AAA repairs were dealt with separately. The data were meta-analysed, and the odds ratios (95 per cent confidence interval) for mortality at higher- and lower-volume hospitals were compared. Volume thresholds were identified from each paper. Results: The analysis included 421 299 elective and 45 796 ruptured AAA operations. Significant relationships between mortality and annual volume were noted for both groups. Overall, the weighted odds ratio was 0.66 (0.65 to 0.67) for elective repair at a threshold of 43 AAAs per annum and (0.73 to 0.82) for ruptured aneurysm repair at a threshold of 15 AAAs per annum, both in favour of high-volume institutions. Conclusion: Higher annual operation volumes are associated with significantly lower mortality in both elective and ruptured AAA repair. This suggests that AAA surgery should be performed only at higher-volume centres. [ABSTRACT FROM AUTHOR]

Background Endovascular aneurysm repair (EVAR) is a new technology to treat patients with abdominal aortic aneurysm (AAA) when the anatomy is suitable. Uncertainty exists about how endovascular repair compares with conventional open surgery. EVAR trial 1 was instigated to compare these treatments in patients judged fit for open AAA repair. Methods Between 1999 and 2003, 1082 elective (non-emergency) patients were randomised to receive either EVAR (n=543) or open AAA repair (n=539). Patients aged at least 60 years with aneurysms of diameter 5.5 cm or more, who were fit enough for open surgical repair (anaesthetically and medically well enough for the procedure), were recruited for the study at 41 British hospitals proficient in the EVAR technique. The primary outcome measure is all-cause mortality and these results will be released in 2005. The primary analysis presented here is operative mortality by intention to treat and a secondary analysis was done in per-protocol patients. Findings Patients (983 men, 99 women) had a mean age of 74 years (SD 6) and mean AAA diameter of 6.5 cm (SD 1). 1047 (97%) patients underwent AAA repair and 1008 (93%) received their allocated treatment. 30-day mortality in the EVAR group was 1.7% (9/531) versus 4.7% (24/516) in the open repair group (odds ratio 0.35 [95% CI 0.16-0.77], p=0.009). By per-protocol analysis, 30-day mortality for EVAR was 1.6% (8/512) versus 4.6% (23/496) for open repair (0.33 [0.15-0.74], p=0.007). Secondary interventions were more common in patients allocated EVAR 9.8% vs 5.8%, p=0.02). Interpretation In patients with large AAAs, treatment by EVAR reduced the 30-day operative mortality by two-thirds compared with open repair. Any change in clinical practice should await durability and longer term results. [ABSTRACT FROM AUTHOR]

Examines changes in the mortality rate from aortic aneurysm in the screened portion of the population in Great Britain. Increase in the rate of detection and increased numbers of elective aneurysm repairs; Influence of the screening program on community mortality rate; Analysis of aneurysm related deaths in men eligible for screening.

The article discusses the programs supported by the National Health Service in England and Scotland about ultrasonographic screening to detect abdominal aortic aneurysms (AAA). It shows that AAA are detectable with ultrasonography for low mortality and reduce cost-effectiveness on screening study. In the study, researchers used a Markov model to estimate the cost-effectiveness of ultrasonographic screening and multiplication of eclectic probabilities.

Abdominal aortic aneurysm (AAA) disease is a condition that affects mainly men over the age of 65 years. The majority of AAAs will remain asymptomatic and therefore undetected. These undetected aneurysms will invariably grow enough for their walls to rupture leading to death in nearly 75% of those affected. Ultrasound-based AAA screening has been shown to reduce the risk of dying of an AAA by half. This significant reduction of mortality offered by a simple and sensitive non-invasive test has prompted the Department of Health to introduce a national AAA screening programme for England and Wales. In this article, the public health risks of AAA disease together with details of the impact of the anticipated national AAA screening programme are discussed. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the declining mortality from abdominal aortic aneurysm (AAA) rupture in Great Britain. The study reviewed routine statistics for mortality, hospital admissions and procedures in England and Wales. It showed a decrease in mortality from AAA among men from 2007 to 2011. It associated the decline to a reduced prevalence of smoking.

BACKGROUND Studies with short-term follow-up have shown that screening for abdominal aortic aneurysm (AAA) is cost-effective and reduces mortality. OBJECTIVE To evaluate the long-term cost-effectiveness and mortality benefit of screening for AAA. DESIGN AND INTERVENTION The Multicentre Aneurysm Screening Study (MASS) was a randomized trial conducted at four centers in the UK between 1997 and 1999. Men aged 65-74 years, identified through family physician records, were eligible for inclusion in the study. Individuals with a terminal illness, previous AAA surgery, or a known AAA, were excluded. Participants were randomly assigned to receive an invitation to AAA ultra-sonography screening or to not receive an invitation. Men with an aortic diameter greater than 3.0cm were classified as having an AAA. Invitations to yearly screening were issued to those with an aortic diameter of 3.0-4.4cm. Screening every 3 months was recommended for those with an aortic diameter of 4.5-5.4 cm. Individuals with signs or symptoms of AAA, an aortic diameter exceeding 5.5cm, or aortic expansion of 1.0cm or more within a year, were eligible for surgery. Rescreening was not offered to participants with an aortic diameter of less than 3.0cm. Patients were followed up through hospital records and the UK Office of National Statistics. The 4-year outcomes of this study have previously been reported. OUTCOME MEASURES The primary end point was AAA-related death. All-cause mortality and cost-effectiveness were also assessed. RESULTS After exclusions, a total of 67,770 men were randomized; 33,883 were assigned to receive invitations to screening and the remaining 33,887 formed the control group. The mean age of participants was 69.2 years for both groups. Screening attendance was high in the invited group (27,204 attended; 80%) and 1,334 men were identified as having an AAA. After 7 years, there had been 14,001 all-cause deaths, of which 301 were AAA-related. In addition, 24% of all participants did not attend recall scans and were, therefore, lost to clinical follow-up. Compared with the control group, the hazard ratio for AAA-related mortality at 7 years in the patients invited for screening was 0.53 (95% CI 0.42-0.68) and 0.96 (95% CI 0.93-1.00) for all-cause mortality. The rate of AAA rupture in men who had an aortic diameter of less than 3.0cm was low at approximately 0.54 ruptures per 100,000 person years. The cost-effectiveness at 7 years was estimated to be US$19,500 (95% CI $12,400-$39,800) per life-year gained for AAA-related mortality and $7,600 (95% CI $3,300-$00 per life-year gained for all-cause mortality. CONCLUSION AAA screening of men aged 65-74 years is cost-effective and is associated with approximately a 50% reduction in AAA-related mortality. [ABSTRACT FROM AUTHOR]

Investigates the correlation between operative workload and in-hospital mortality for elective and emergency operations on aortic aneurysm in a study in Great Britain. Total number of operations investigated; Findings revealed by parabolic regression and log-arithmetic transformation; Observation on the mortality rate of patients.