Abdominal aortic aneurysm: high prevalence in men over 59 years of age with TIA or stroke, a perspective

Abstract

Death resulting from a ruptured abdominal aortic aneurysm (AAA) is potentially preventable. Screening for AAA is cost-effective, reducing risk of AAA-related death by 50%. For various reasons screening programs have not been implemented widely. Therefore, the need to identify subgroups with increased prevalence of AAA remains. Recently, men over 59 years of age presenting with stroke or a transient ischemic attack (TIA) at the neurology department were found to have a doubled prevalence of AAA. This confirmed data of another study (SMART), which included broader inclusion criteria (either manifest atherosclerotic disease or only risk factors for atherosclerosis). Incorporation of an aortic ultrasonography into the neurological work up of these patients could result in an effective screening program. However, before that, several cost-effectiveness issues need to be resolved, such as growth rate of the detected aneurysms, risk of death by AAA rupture in this patient group with increased co-morbidity and decreased life expectancy, peri-operative risk of open or endovascular repair.