Aged; Aortic Aneurysm, Abdominal/diagnostic imaging; Aortic Aneurysm, Abdominal/epidemiology; Cross-Sectional Studies; Echocardiography/methods; Feasibility Studies; Female; France/epidemiology; Humans; Male; Mass Screening/methods; Prevalence; Prospective Studies; Reproducibility of Results; Risk Factors; Sex Distribution; Sex Factors; Cardiology and Cardiovascular Medicine
Abstract :
[en] Screening patients with abdominal aortic aneurysm (AAA) is associated with reduced AAA-related mortality, but population screening is poorly implemented. Opportunistic screening during imaging for other indications might be efficient. Single-center series reported AAA rates of 0.8% to 6.5% in patients undergoing transthoracic echocardiography (TTE), with disparities due to selection bias. In this first multicenter study, we aimed to assess the feasibility and criteria for screening AAA during TTE in real-life practice. During a week of May 2011, 79 centers participated in a nationwide survey. All patients aged ≥65 years requiring TTE for any indication were eligible, except for those with operated abdominal aorta. We defined AAA by an anteroposterior diameter of the infrarenal aorta≥30 mm. Of 1,382 consecutive patients, abdominal aorta imaging was feasible in 96.7%, with a median delay of 1.7 minutes (>3 minutes in 3.6% of cases). We found AAA in 50 patients (3.7%). Unknown AAA (2.7%) was more frequent in men than women (3.7% vs 1.3%, respectively, p=0.007) and increased by age at 2.2%, 2.5%, and 5.8% in age bands of 65 to 74, 75 to 84, and 85+ years, respectively. None of the female participants aged <75 years had AAA. Smoking status and family history of AAA were significantly more frequent among patients with AAA. The ascending aorta was larger in those with AAA (36.2±4.7 vs 34.0±5.2 mm, p=0.006), and bicuspid aortic valve and/or major aortic regurgitation were also more frequent (8% vs 2.6%, p=0.017). In conclusion, rapid AAA screening during TTE is feasible and should be limited to men ≥65 years and women≥75 years.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Aboyans, Victor; Department of Cardiology, Dupuytren University Hospital, Limoges, France, INSERM U1094, Tropical Neuroepidemiology, Limoges University, Limoges, France. Electronic address: victor.aboyans@unilim.fr
Bataille, Vincent; Department of Cardiology, Rangueil University Hospital, Toulouse, France
Bliscaux, Pascale; Cardiology Center, Saint-Avold, France
Ederhy, Stéphane; Department of Cardiology, Saint-Antoine University and Medical School, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie, Paris, France
Filliol, Didier; Cardiology Center, Draguignan, France
Honton, Benjamin; Department of Cardiology, Rangueil University Hospital, Toulouse, France
Kurtz, Baptiste; Department of Cardiology, Rouen University Hospital, Rouen, France
Messas, Emmanuel; Department of Vascular Medicine, Hôpital Européen Georges Pompidou, Paris, France
Mohty, Dania; Department of Cardiology, Dupuytren University Hospital, Limoges, France, INSERM U1094, Tropical Neuroepidemiology, Limoges University, Limoges, France
Brochet, Eric; Department of Cardiology, Bichat-Claude-Bernard University Hospital, Paris, France
Kownator, Serge; Cardiology Center, Thionville, France
investigators of the E2T3A study
Sprynger, Muriel ; Université de Liège - ULiège > Département des sciences cliniques
The study was supported by unrestricted grants from AstraZeneca Laboratories , Paris, France. This study has been supported by the Working Group of Vascular Diseases/Thrombosis and the Council of Echocardiography of the French Society of Cardiology, Paris, France .
V. Aboyans, S. Kownator, M. Lafitte, E. Brochet, J. Emmerich, C. Tribouilloy, S. Lafitte, and M. Ferrini Screening abdominal aorta aneurysm during echocardiography: literature review and proposal for a French nationwide study Arch Cardiovasc Dis 103 2010 552 558
C. van Walraven, J. Wong, K. Morant, A. Jennings, P. Jetty, and A.J. Forster Incidence, follow-up, and outcomes of incidental abdominal aortic aneurysms J Vasc Surg 52 2010 282 289
H. Takagi, S.N. Goto, M. Matsui, H. Manabe, and T. Umemoto A contemporary meta-analysis of Dacron versus polytetrafluoroethylene grafts for femoropopliteal bypass grafting J Vasc Surg 52 2010 110 118
U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ). Evidence Synthesis Number 35: Primary Care Screening for Abdominal Aortic Aneurysm 2005 1 28
111th US Congress. Screening Abdominal Aortic Aneurysms Very Efficiently Act of 2009. Available at: http://www.govtrack.us/congress/bills/111/hr1213. Accessed on May 13, 2013.
J.B. Shreibati, L.C. Baker, M.A. Hlatky, and M.W. Mell Impact of the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act on abdominal ultrasonography use among Medicare beneficiaries Arch Intern Med 172 2012 1456 1462
P.W. Stather, N. Dattani, M.J. Bown, J.J. Earnshaw, and T.A. Lees International variations in AAA screening Eur J Vasc Endovasc Surg 45 2013 231 234
F.A. Lederle The rise and fall of abdominal aortic aneurysm Circulation 124 2011 1097 1099
P.E. Norman, K. Spilsbury, and J.B. Semmens Falling rates of hospitalization and mortality from abdominal aortic aneurysms in Australia J Vasc Surg 53 2011 274 277
A.J. MacDonald, O. Faleh, G. Welch, and S. Kettlewell Missed opportunities for the detection of abdominal aortic aneurysms Eur J Vasc Endovasc Surg 35 2008 698 700
M. Alund, K. Mani, and A. Wanhainen Screening for abdominal aortic aneurysm among patients referred to the vascular laboratory is cost-effective Eur J Vasc Endovasc Surg 39 2010 208 216
M.J. Eisenberg, S.J. Geraci, and N.B. Schiller Screening for abdominal aortic aneurysms during transthoracic echocardiography Am Heart J 130 1995 109 115
K.V. Schwartz, A.M. Rashkow, and M.S. Akella Detection of abdominal aortic aneurysm during routine echocardiography Echocardiography 13 1996 71 73
P. Spittell, J. Ehrsam, L. Anderson, and J.B. Seward Screening for abdominal aortic aneurysm during transthoracic echocardiography in a hypertensive patient population J Am Soc Echocardiogr 10 1997 722 727
A. Jaussi, P. Fontana, and X.M. Mueller Imaging of the abdominal aorta during examination of patients referred for transthoracic echocardiography Schweiz Med Wochenschr 129 1999 71 76
M.H. Seelig, Y.L. Malouf, P.J. Klingler, W.A. Oldenburg, and E.J. Atkinson Clinical utility of routine screening for abdominal aortic aneurysm during echocardiography Vasa 29 2000 265 268
F. Bernard, F. Revel, R. Richard, H. Broustet, and J.P. Ollivier Dépistage de l'anévrysme de l'aorte abdominale sous-rénale lors d'une échocardiographie Ann Cardiol Angeiol 51 2002 377 381
S. Gianconni, F. Lattanzi, E. Orsini, R. Prosperi, and G. Tartarini Feasibility and accuracy of a rapid evaluation of the abdominal aorta during routine transthoracic echocardiography Ital Heart J Suppl 4 2003 332 336
S.C. Bekkers, J.H. Habets, E.C. Cheriex, A. Palmans, Y. Pinto, L. Hofstra, and H.J. Crijns Abdominal aortic aneurysm screening during transthoracic echocardiography in an unselected population J Am Soc Echocardiogr 18 2005 389 393
M. Ruggiero, M.L. Lenti, D. Cavallari, C.P. Dicillo, A.R. Mascolo, S. Musci, F. Tota, G. Sabato, C. Tortorella, D. Damiani, P. Colonna, and G. Franchini Screening for abdominal aortic aneurysm during transthoracic echocardiography. A prospective study in 1202 consecutive patients at high risk: incidence, correlation with risk factors, feasibility, diagnostic accuracy, and increase in echocardiography time G Ital Cardiol (Rome) 7 2006 217 223
F. Roshanali, M.H. Mandegar, M.A. Yousefnia, A. Momammadi, and B. Baharvand Abdominal aorta screening during transthoracic echocardiography Echocardiography 24 2007 685 688
D.I. Gentille-Lorente, and T. Salvado-Usach Screening for abdominal aortic aneurysm by means of transthoracic echocardiography Rev Esp Cardiol 64 2011 395 400
E.V. Navas, A. McCalla-Lewis, B.B. Fernandez Jr., S.L. Pinski, G.M. Novaro, and C.R. Asher Abdominal aortic aneurysm screening during transthoracic echocardiography: cardiologist and vascular medicine specialist interpretation World J Cardiol 4 2012 31 35
S.H. Forsdahl, K. Singh, S. Solberg, and B.K. Jacobsen Risk factors for abdominal aortic aneurysms: a 7-year prospective study: the Tromsø Study, 1994-2001 Circulation 119 2009 2202 2208
F.A. Lederle, G.R. Johnson, S.E. Wilson, E.P. Chute, R.J. Hye, M.S. Makaroun, G.W. Barone, D. Bandyk, G.L. Moneta, and R.G. Makhoul 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 2000 1425 1430
G.A. Laughlin, M.A. Allison, N.E. Jensky, V. Aboyans, N.D. Wong, R. Detrano, and M.H. Criqui Abdominal aortic diameter and vascular atherosclerosis: the Multi-Ethnic Study of Atherosclerosis Eur J Vasc Endovasc Surg 41 2011 481 487
M.S. Freiberg, A.M. Arnold, A.B. Newman, M.S. Edwards, K.L. Kraemer, and L.H. Kuller Abdominal aortic aneurysms, increasing infrarenal aortic diameter, and risk of total mortality and incident cardiovascular disease events: 10-year follow-up data from the Cardiovascular Health Study Circulation 117 2008 1010 1017
G. Rughani, L. Robertson, and M. Clarke Medical treatment for small abdominal aortic aneurysms Cochrane Database Syst Rev 9 2012 CD009536
K. Singh, K.H. Bønaa, S. Solberg, D.G. Sørlie, and L. Bjørk Intra- and interobserver variability in ultrasound measurements of abdominal aortic diameter. The Tromsø Study Eur J Vasc Endovasc Surg 15 1998 497 504
