Epidemiology of abdominal aortic aneurysm in an Asian population

Background: Abdominal aortic aneurysms (AAA) are common in the Caucasian population. Apart from reported differences in the occurrence of AAA in the black and white populations, there are few studies on the incidence of AAA in the Asian population. Methods: A prospective database of all patients with AAA seen between 1996 and 1999, in the South‐East Asian state of Sarawak in Borneo Island, was analysed. The demographic data included patient's age, sex, ethnic group, date of diagnosis, comorbidities, presentations and treatment outcomes. These were compared with the state population's demographic statistics. Results: Diagnoses of AAA were made in 123 patients during the study period. The male to female ratio was 3.5 : 1. The age range was 39?88 years with a median age of 70 years. Four patients were younger than 55 years. The incidence rate for the at‐risk male population older than 50 years was 25.6/100 000. The incidence rate reached 78.3/100 000 for males older than 70 years. The incidence rate for females older than 50 years was 7.6/100 000 and for those older than 70 years it was 18.7/100 000. All races were affected. Smoking, hypertension or respiratory disorders were present in more than 40% of the patients. Half of the patients underwent surgical repair. Conclusion: This study shows that AAA in this Asian population is not uncommon and the incidence is comparable to the Western world.     

Project PROMIS: Peoria Regional Outpatient Medical Imaging Study

BACKGROUND: Abdominal aortic aneurysm (AAA) accounts for > 15,000 reported deaths annually. Early screening in high-risk populations is important to decrease morbidity and mortality from rupture. METHODS: A prospective, population-based study of free ultrasound-based AAA screening was conducted from July 2004 to December 2006. Before examination, subjects completed surveys asking their medical history, including known AAA risk factors. Incidence rates and comparison analyses were performed. RESULTS: The final analysis included 979 patients, of whom AAA was discovered in 27 (2.8%). AAA was found in only male patients > 60 years old (4% of the male population). AAA size ranged from 3 to 10 cm. Of patients diagnosed with AAA, 85% were current or past smokers, and 70% had hypercholesterolemia. There was a 6% incidence of AAA in male smokers > or = 60 years old who had hypercholesterolemia. CONCLUSIONS: Four factors were predominant in our population of patients with AAA: patient age, male sex, smoking history, and hypercholesterolemia.     

Myocardial damage in high-risk patients undergoing elective endovascular or open infrarenal abdominal aortic aneurysm repair.

OBJECTIVE: Dobutamine stress echocardiography (DSE) provides an objective assessment of the presence and extent of coronary artery disease. Therefore we compared cardiac outcome in patients at high-cardiac risk undergoing open or endovascular repair of infrarenal AAA using preoperative DSE results. METHODS: Consecutive patients with >or=3 cardiac risk factors (age >70 years, angina pectoris, myocardial infarction, heart failure, stroke, renal failure, and diabetes mellitus) undergoing infrarenal AAA repair were reviewed retrospectively. All underwent cardiac stress testing using DSE. Postoperatively data on troponin release and ECG were collected on day 1, 3, 7, before discharge, and on day 30. The main outcome measures were perioperative myocardial damage and myocardial infarction or cardiovascular death. RESULTS: All 77 patients (39 endovascular, 38 open) had a history of cardiac disease. The number and type of cardiac risk factors were similar in both groups. Also DSE results were similar: 55 vs 56%, 24 vs 28%, and 21 vs 18% had no, limited, or extensive stress induced myocardial ischemia respectively. The incidence of perioperative myocardial damage (47% vs 13%, p=0.001) and the combination of myocardial infarction or cardiovascular death (13% vs 0%, p=0.02) was significantly lower in patients receiving endovascular repair. CONCLUSION: In patients with similar high cardiac risk, endovascular repair of infrarenal aortic aneurysms is associated with a reduced incidence of perioperative myocardial damage.     

Abdominal aortic aneurysm in women: prevalence, risk factors, and implications for screening

OBJECTIVE: Accurate data regarding the prevalence and associated risk factors for aneurysmal disease is essential when determining the appropriateness of screening for abdominal aortic aneurysms (AAA). Although women are poorly represented in most large studies of AAA prevalence, the US Preventative Services Task Force recently recommended against primary screening for AAA in women. The purpose of this analysis was to define the prevalence and risk factors associated with the development of AAA in women. METHODS: A free duplex ultrasound screening was offered to men and women with cardiovascular risk factors or a family history of AAA. Patients were recruited through advertising at local screening centers and screenings were performed between 2004 and 2006. Demographic information and cardiovascular and aneurysmal disease risk factors were obtained for each patient through a questionnaire. A total of 17,540 subjects were screened for AAA, including 10,012 women (mean age 69.6 years) and 7528 men (mean age 70.0 years). Univariate and multivariable logistic regression analysis was performed on the subset of women that were screened to determine risk factors for and prevalence of AAA. RESULTS: Seventy-four aneurysms were detected in women (including four aneurysms >5 cm diameter and 70 aneurysms 3 to 5 cm diameter) while 291 were detected in men, resulting in prevalence rates of 0.7% and 3.9%, respectively. Increasing age (odds ratio [OR]= 4.57, 95% confidence interval [CI] 1.98 to 10.54, P < .0001), history of tobacco use (OR = 3.29, 95% CI 1.86 to 5.80, P < .0001), and cardiovascular disease (OR= 3.57, 95% CI 2.19 to 5.84, P < .0001) were independently associated with AAA in women on univariate and multivariable analysis. Women with multiple atherosclerotic risk factors were more commonly found to have AAAs and had a prevalence rate of AAA as high as 6.4%. CONCLUSION: Although the medical literature suggests a low prevalence rate of AAA in women in the general population, specific risk factors are associated with the development of AAA, and subgroups of women can be identified that are at a substantially increased risk of aneurysmal disease. In particular, elevated rates of AAA were found among women of advanced age (> or =65 years) with a history of smoking or heart disease. These data support the notion that women with such risk factors should be considered for AAA screening.     

Growth predictors and prognosis of small abdominal aortic aneurysms

OBJECTIVE: Evidence regarding the influence of cardiovascular risk factors, comorbidities, and patient characteristics on the growth of small abdominal aortic aneurysms (AAA) is limited. We assessed, in an observational cohort study, rupture rates, risks of mortality, and the effects of cardiovascular risk factors and patient demographics on growth rates of small AAAs. METHODS: Between September 1996 and January 2005, 5057 patients with manifest arterial vascular disease or cardiovascular risk factors were included in the Second Manifestation of ARTerial disease (SMART) study. Measurements of the abdominal aortic diameter were performed in all patients. All patients with an initial AAA diameter between 30 and 55 mm were selected for this study. All AAA measurements during follow-up until August 2007 were collected. Multivariate regression analysis was performed to calculate the effects of demographic patient characteristics, initial AAA diameter, and cardiovascular risk factors on AAA growth. RESULTS: Included were 230 patients, with a mean age of 66 years and 90% were male. Seven AAA ruptures (six fatal) occurred in 755 patient years of follow-up (rupture rate 0.9% per patient-year). In 147 patients, AAA measurements were performed for a period of more than 6 months. The median follow-up time was 3.3 years (mean 4.0, range 0.5 to 11.1 years, standard deviation (SD) 2.5). Mean AAA diameter was 38.8 mm (SD 6.8) and mean expansion rate 2.5 mm/y. Patients using lipid-lowering drugs had a 1.2 mm/y (95% confidence interval [CI] -2.34 to -0.060 mm/y) lower AAA growth rate compared to nonusers of these drugs. Initial AAA diameter was associated with a 0.09 mm/y (95% CI 0.01 to 0.18 mm/y) higher growth rate per millimetre increase of the diameter. No other factors, including blood lipid values, were independently associated with AAA growth. CONCLUSIONS: Lipid-lowering drug treatment and initial AAA diameter appear to be independently associated with lower AAA growth rates. The risk of rupture of these small abdominal aortic aneurysms was low, which pleads for watchful waiting.     

High prevalence of abdominal aortic aneurysm in men with peripheral vascular disease: screening by ultrasonography

A study was carried out to see if an ultrasonic examination of the abdominal aorta was indicated in every patient who attended an outpatient clinic with peripheral vascular disease (PVD). One hundred consecutive patients were studied and compared with a control group. The incidence of abdominal aortic aneurysm (AAA) in the control group was 2 per cent. In the study group, the male patients had an incidence of 20 per cent of aneurysm and ectasia, while the female patients had an incidence of 12 per cent. Of all the abnormal aortas found by ultrasound, only 31 per cent were palpable clinically. Two aneurysms that required operation were found, while the remainder are to be followed by regular ultrasound assessment. Further studies are necessary to conclude if screening of a high risk group, such as patients with PVD, is worthwhile.     

The value of screening in siblings of patients with abdominal aortic aneurysm.

OBJECTIVES: This study aimed to determine the incidence of abdominal aortic aneurysm (AAA) in a large group of siblings of Australian AAA patients to determine if screening in this group is justified. METHODS: 1254 siblings of 400 index AAA patients were identified and offered aortic ultrasound screening. An age and sex matched control group was recruited from patients having abdominal CT scans for non-vascular indications. AAA was defined by an infrarenal aortic diameter of > or =3 cm or a ratio of the infrarenal to suprarenal aortic diameter of > or =2.0. A ratio of 1.0-1.5 was considered normal, and a ratio of >1.5 to <2.0 was considered ectatic. Aortic enlargement was defined as ectasia or aneurysm. RESULTS: 276 (22%) siblings could be contacted and agreed to screening or had previously been diagnosed with AAA. All 118 controls had normal diameter aortas. 55/276 siblings had previously been diagnosed with AAA. The remaining 221 siblings underwent ultrasound screening. Overall, 30% (84/276) had enlarged aortas (5% ectasia, 25% aneurysmal); 43% of male siblings (64/150) and 16% of females siblings (20/126). The incidence was 45% in brothers of female index patients, 42% in brothers of male patients, 23% in sisters of female patients, and 14% in sisters of male index patients. CONCLUSIONS: The overall incidence of aortic enlargement of 30% found in this study warrants a targeted screening approach with ultrasound for all siblings of patients with AAA. A similar targeted approach for screening of the children of AAA patients would also seem advisable.     

High prevalence of unsuspected abdominal aortic aneurysms in patients hospitalised for surgical coronary revascularisation.

OBJECTIVES: Prevalence of abdominal aortic aneurysms (AAA) is not exactly known among patients with coronary artery disease (CAD) who are considered for surgical revascularisation. We evaluated the value of screening AAA among coronary patients admitted in our cardiovascular surgery unit. METHODS: Over a 24-month period, an abdominal echography was proposed to male patients aged 60 or more while hospitalised for surgical coronary revascularisation. Patients with previous investigation of the aorta were excluded. The aorta was considered aneurysmal when the anterior-posterior diameter was of 30 mm or more. RESULTS: Three hundred and ninety-five consecutive patients all accepted a proposed abdominal echographic screening for AAA. Forty unsuspected AAA were detected (10.1%). The mean diameter was 38.9 +/- 1.3 mm. Four AAA were larger than 50 mm and considered for surgery after the CABG procedure. Surveillance was proposed to the other 36, especially the 10 patients with an AAA larger than 40 mm. Patients with AAA were significantly older than those without AAA (71.3 +/- 0.8 vs. 69.4 +/- 0.3 years, P<0.05). Smoking history (P<0.05) and hypertension (P<0.05) were also associated more frequently with AAA. More than 16% of the patients being smokers and suffering hypertension presented with unsuspected AAA. CONCLUSIONS: In-hospital screening of AAA is very efficient among patients with coronary artery disease. Therefore, patients with CAD may be considered for routine AAA screening.     

The influence of aneurysm size on perioperative cardiac outcome in elective open infrarenal aortic aneurysm repair

BACKGROUND: Abdominal aortic aneurysm (AAA) size and growth has been found to be associated with local generation of inflammation markers such as interleukin-6. Inflammation also seems to be important in perioperative adverse cardiac events. We hypothesized that patients with a large AAA are at increased risk for cardiac events. METHODS: Consecutive patients who underwent a computed tomography angiography scan before open elective infrarenal AAA repair between March 2000 and December 2005 at three hospitals were analyzed. All patients were screened for the clinical risk factors of age, gender, angina pectoris, myocardial infarction, heart failure, diabetes, stroke, renal failure, and chronic obstructive pulmonary disease, as well as for cardioprotective medication. Postoperative data on troponin release, creatine kinase/creatine kinase isoenzyme MB, and electrocardiogram were routinely collected on days 1, 3, 7, and 30. The main outcome measure was the combined end point of 30-day cardiovascular death and nonfatal myocardial infarction. Multivariate Cox regression analysis was used to evaluate the influence of AAA size on postoperative cardiac outcome. RESULTS: The study included 500 patients. Their mean age was 69.8 +/- 9.5 years, and 431 (86%) were men. Thirty-one patients (6.2%) had perioperative cardiovascular complications, consisting of 15 (3.0%) cardiovascular deaths and 16 (3.2%) nonfatal myocardial infarctions. After correction for other risk factors, including age, Revised Cardiac Risk Index, medication use, duration of surgery, and intraoperative blood loss, AAA size was independently associated with perioperative nonfatal myocardial infarction and cardiovascular death (3.2% increase in risk for each millimeter added, 95% confidence interval 1.1% to 6.2%, P = .007). CONCLUSION: A larger AAA size is independently associated with an increased incidence of perioperative cardiovascular complications after elective infrarenal AAA repair.     

Concomitant Detection of Systemic Atherosclerotic Disease while Screening for Abdominal Aortic Aneurysm

Introduction Although population screening for abdominal aortic aneurysm (AAA) has/had a significant impact on disease-specific mortality, coexisting systemic atherosclerosis represents the major impediment to improved longevity. We examined the feasibility and yield of full cardiovascular assessment concomitant with screening for AAA detection. Methods A total of 1032 asymptomatic men over the age of 50 years (328 were >60 years) underwent a detailed cardiac health questionnaire, sphygmomanometry, body mass index calculation, fasting lipid profiling, ultrasonographic (US) examination of their infrarenal aorta and carotid arteries, and treadmill exercise stress testing. Framingham and SCORE project estimations of the 10-year risk of ischemic heart disease (IHD) and fatal cardiovascular disease (CVD) of any cause were calculated for the men with an AAA and in those >60 years but with neither AAA nor known cardiac disease. Results Overall, we detected an AAA >3 cm in 30 men (2.9%). Unaddressed obesity, smoking, hypertension, impaired glucose metabolism, and hypercholesterolemia were commonly identified in individuals both with and without an AAA, being notably frequent in those >60 years without an AAA. The 10-year risk of IHD and CHD in those >60 years was similar regardless of whether an AAA was present. Doppler screening for significant carotid stenosis had detection rates similar to those for aortic US scanning, being most useful in those >65 years of age. Exercise stress testing, however, was of only limited value when used nonselectively. Conclusions Modifiable atherosclerotic disease and cardiovascular risk can be readily detected in individuals presenting for AAA screening and are present to a significant degree at an earlier age. Consideration of selected, additional investigations is required to maximize the value of generalized screening programs.     

The low prevalence of abdominal aortic aneurysm in relatives in Northern Ireland.

INTRODUCTION: Mortality from ruptured abdominal aortic aneurysm (AAA) remains high and has given impetus to screening. Targeted screening towards high-risk groups would increase efficacy. Relatives of previous AAA patients have been suggested as one such group. The aim of this study was therefore to determine the prevalence of AAA in relatives of previous patients in Northern Ireland. PATIENTS AND METHODS: All living AAA patients, who underwent surgery between August 2001 and December 2005 in our unit, or were attending for follow-up of small aneurysms were contacted and asked for details of siblings and their family history. Screening by ultrasound was offered to the siblings and children over 50 years, with a defining threshold diameter for an aneurysm of 3.0 cm. Overall prevalence of AAA in the relatives was calculated. Separate prevalence rates were calculated according to relationship and gender of the patient and relative. RESULTS: 513 previous patients were contacted. 132 gave details of living relatives, resulting in a total of 405 relatives suitable for screening. 105 declined a scan, leaving 300 in the study. Overall mean age of the group was 63.0+/-8.7 years and 68% were siblings of male patients. Overall ten AAAs were detected by screening, giving a prevalence of 3.3%. No aneurysms were found in the subgroup of children, while the highest prevalence (12.5%) was found in brothers of female patients. 20 additional AAAs were reported in these 132 families, resulting in 14 of the 132 families (10.6%) having two or more members with AAA. CONCLUSION: The prevalence of screening detected AAA in this study is lower than anticipated. The reason is unclear, but demonstrates the multifactorial nature of the aetiology and genetic complexities yet to be unravelled by future research.     

Ultrasound screening for abdominal aortic aneurysms in patients with atherosclerotic peripheral vascular disease

The rapidly rising incidence of abdominal aortic aneurysm (AAA) and the grave prognosis in cases of rupture call for early detection and operative intervention. However, there is as yet no consensus on which groups in the population should be selected for screening. Some Authors have suggested the screening of populations at risk by virtue of their age, sex and/or the presence of arterial hypertension, and report the incidence of AAA in these populations as 5.3%, 3.4% and 0.25%, respectively. In this study we screened a group of patients with atherosclerotic peripheral vascular disease. Within this group the incidence of aneurysms was found to be 5.9%, which is at least twice the estimated incidence in the general population. Three of the six patients discovered, successfully underwent surgery. We conclude that screening of this specific population group is considerably more cost-effective than universal screening.     

Perioperative mangement of surgery for abdominal aortic aneurysm associated with coronary artery disease

BACKGROUND: Patients undergoing abdominal aortic aneurysm (AAA) surgery are at increased risk of perioperative cardiovascular complications due to underlying coronary artery disease (CAD). We determined retrospectively the incidence of CAD and the influence of coronary revascularization and perioperative cardiovascular complications in patients for AAA surgery. METHODS: Routine coronary angiography (CAG) was performed in 159 patients prior to elective AAA surgery to estimate the presence of CAD. To compare risk factors and perioperative cardiovascular complications the patients were divided at the time of CAG into three groups: previously diagnosed CAD, newly diagnosed CAD and non-CAD. RESULTS: Preoperative CAG found 129 patients (81%) with CAD. Among newly diagnosed patients 82% were asymptomatic of CAD. Forty-four patients (28%) underwent coronary revascularization (17 percutaneous coronary intervention, 3 preoperative coronary artery bypass grafting, and 24 combined coronary artery bypass grafting). Perioperative cardiac complications occurred in 35 patients (22%). No significant difference was found among the three groups in the incidence of perioperative cardiovascular complications. Two patients with severe CAD not treated with coronary revascularization died of cardiac events. CONCLUSIONS: Perioperative management and coronary revascularization should be carried out with more cautions in AAA patients to reduce the incidence of cardiovascular complications after AAA surgery.     

The incidence of small abdominal aortic aneurysms and the change in normal infrarenal aortic diameter: implications for screening.

AIM: to study the incidence of small abdominal aortic aneurysms (AAA), and to investigate what proportion of normal infrarenal aortic diameters (IAD) expand with age. METHODS: longitudinal follow-up in a population-based aneurysm screening programme. The infrarenal aortic diameter (IAD) was measured by ultrasound. A second scan was performed in subjects with a normal aorta after an average of 5.5 years. RESULTS: data were analysed from 4072 subjects, 464 with a small AAA and 3608 with a normal aorta. The infrarenal aorta expanded in 15% of subjects, but significant growth (>5 mm) occurred in only 7%. Age and initial diameter were independent predictors for aortic dilatation. The effect of diameter at first screen was non-linear. The relative risk for expansion increased dramatically for IADs over 2.5 cm (test for departure of trend: chi2=52, p<0.0001). The effect of age was also non-linear, the risk of expansion was highest in the 60-69 year old age group; test for departure of trend (chi2=13, p=0.002). The incidence of new aneurysms was 3.5 per 1000 person-years (py) (95% CI: 2.8-4.4). The highest incidence of new aneurysms was found in the 60 to 69 year old age group. CONCLUSION: only a small proportion of the population is prone to aortic dilatation. Patients over 70 with an IAD <2.5 cm can be discharged from follow-up.     

The true incidence of ruptured abdominal aortic aneurysms

The number of ruptured abdominal aortic aneurysms (RAAA) was documented over an 8-year-period in a known population age group. Patient figures were collected from the operative and post-mortem registers in the Worthing Health District. The overall mean incidence of RAAA was 13.9/100,000 patient years, although the incidence was noted to increase from 9.2 to 17.5/100,000 patient years during this period. The incidence in the male population rose from 4.7/100,000 for those in the fifth decade to 184.8/100,000 for those above 80. For patients undergoing operation, the peri-operative survival was 38%, however the overall survival was 11% as 64% of patients died at home. These figures demonstrate an increasing incidence of ruptured AAA. They also add support to the need for screening of asymptomatic abdominal aortic aneurysms and elective repair if the incidence and hence mortality is to be reduced.     

The cost-effectiveness of a "quick-screen" program for abdominal aortic aneurysms

BACKGROUND: The incidence of abdominal aortic aneurysm (AAA) is increasing, and the prognosis of ruptured AAA remains dismal. Early diagnosis and intervention are crucial. We designed this study to determine whether selected population screening with a brief "quick-screen" ultrasound could be cost-effective. METHODS: A series of 25 patients with risk factors for AAA were evaluated in a blinded fashion by a quick-screen ultrasound and a full conventional study. Times and accuracy for the 2 approaches were compared. An analysis of the cost-effectiveness of screening for AAA was then performed using a Markov model. We determined the long-term survival in quality-adjusted life years and lifetime costs for a hypothetical cohort of 70-year-old males undergoing either AAA screening or not. Our measure of outcome was the cost-effectiveness ratio (CER). RESULTS: The average time for a quick screen was one-sixth that of a conventional study (4 vs 24 minutes). The accuracy of the quick screen was 100%. In our base-case analysis, screening for AAA was cost-effective with a CER of $11,215. Society usually is willing to pay for interventions with CER of less than $60,000 (eg, CER for coronary artery bypass grafting, $9500; breast cancer screening, $16,000). In sensitivity analysis, reducing the cost of screening from $259 (approximate Medicare reimbursement) to $40 (the quick screen) improved the CER to $6850. Moreover, screening populations with increased prevalence of AAA (eg, male with family history [18%]) further improved the CER. CONCLUSIONS: Our analysis demonstrates that ultrasound screening for AAA should be offered to all males above the age of 60. Widespread screening for AAA should be adopted and reimbursed by Medicare and other insurers.     

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.

BACKGROUND: Cardiovascular diseases and chronic obstructive pulmonary disease (COPD) are both associated with abdominal aortic aneurysms (AAA). The aim of this study was therefore to analyse whether screening for AAA could be restricted to men with such diseases (high risk group). METHODS: Before the date of randomisation of a population screening trial of 12,639 64-73-year-old males, all discharge diagnoses from the National Patient Registry concerning AAA-related diseases were merged with the screening results on attendance, AAA prevalence, and AAA-related mortality and overall mortality. Differences in proportions were compared by Chi square tests and differences in mortality by Cox regression analyses. RESULTS: The attendance rate was 78.8% and 6.7% had an AAA in the high risk group compared to 75.8% attendance (P<0.001) and 2.9% (P<0.001) in the remaining population. Cumulatively, screening of only high risk men with would have required 72.9% (95% C.I.: 72.3-74.5%) fewer screening invitations, would have discovered 46.1% (95% C.I.: 38.9-53.4%) of the AAA cases diagnosed and prevented 46.7% (95% C.I.: 28.3-65.7%) of the AAA-related deaths. However, screening decreased AAA-related mortality both among men with and without known COPD or cardiovascular diseases: mortality ratio: 0.22 (95% C.I.: 0.08-0.65), P=0.006, and 0.24 (95% C.I: 0.09-0.63, P=0.004, respectively. CONCLUSION: High-risk population screening would prevent less than half of AAA-related deaths. Therefore, restricting screening to such high-risk groups does not seem justified, but cost effectiveness analyses are needed to reach a firm conclusion.     

Cost-effectiveness of different screening strategies for abdominal aortic aneurysm

OBJECTIVE: The primary objective of this study was to develop a simulation model to assess the cost-effectiveness of different screening strategies for abdominal aortic aneurysms (AAAs) in men. METHODS: A systematic review of the literature was conducted for different screening strategies in terms of age (60, 65, or 70 years) and risk profiles (all men or specific high-risk groups) of the screened population, and rescreening after 5 or 10 years. These data were analyzed in a Markov simulation cohort model. RESULTS: The cost per life year gained for different screening strategies ranged from US 8,309 dollars to US 14,084 dollars and was estimated at US 10,474 dollars when 65-year-old men were screened once. Screening 60-year-old men was equally cost-effective, with the advantage of more life years gained. We demonstrated a trade-off between high prevalence of AAA and lower life expectancy, eliminating the expected benefits of screening high-risk groups such as smokers (US 10,695 dollars) or cardiovascular patients (US 10,392 dollars). Assuming general population utility resulted in a cost per quality-adjusted life year (QALY) gained of US 13,900 dollars, whereas a hypothetical 5% reduction in utility among men with a screening-detected AAA raised the cost per QALY gained to US 75,100 dollars. CONCLUSION: This Markov model, which was based on a systematic review of the literature, supplied information on the estimated cost-effectiveness of different screening strategies. Screening men for AAA may be cost-effective in the long-term. Different screening strategies and quality-of-life effects related to screening for AAA need to be evaluated in future clinical studies.     

Preoperative cerebrovascular screening before cardiovascular surgery in a high risk area of cerebrovascular events in Japan

BACKGROUND: Cerebrovascular disease and cervical artery diseases are potentially treatable conditions that are associated with an increased incidence of stroke after cardiac surgery. This prospective study was designed to determine the prevalence of cerebrovascular diseases in the high risk population of cerebrovascular event including some young patients in Japan and establish the strategy for cardiac surgery of patients with cerebrovascular disease. METHODS: 100 (71 male, 29 female) of 126 consecutive patients undergoing cardiac surgery under cardiopulmonary bypass were screened for the presence of cerebrovascular disease by intra-arterial angiogram. RESULTS: In seven patients angiographic evaluation disclosed some evidence of cerebrovascular disease for 50% or greater stenosis or cerebral aneurysm. Preoperative 99mTc-Hexamethyl propylene amino oxime (99mTc-HMPAO) single emission computed tomography (SPECT) with combination of balloon arterial occlusion test provided detailed information of cerebral ischemic tolerance and reliable decision making for surgical repair of cerebrovascular disease. No deaths were recorded and a small stroke in one patient. CONCLUSIONS: We concluded that cerebrovascular screening in patients with cardiovascular disease may be requested in a high risk population of cerebrovascular events.