Commentary on ‘Low Post-operative Mortality after Surgery on Patients with Screening-detected Abdominal Aortic Aneurysms: A Swedvasc Registry Study’

Abstract

Death from abdominal aortic aneurysm (AAA) rupture can be significantly lowered through single screening with ultrasound scan in men aged 65e74 years. Nevertheless, AAA screening is not without risks. It is therefore a mandatory requirement that AAA screening programmes inform potential participants of any possible adverse outcomes. In the UK the National Health Service Abdominal Aortic Aneurysm Screening Program summarises the risks involved clearly and unambiguously in its standard national information leaflet sent to all men on invitation. Historically, there were concerns over the implementation of a national AAA screening programme in the UK owing to high mortality after elective AAA repair (7.5%d double the average for the rest of Europe). Following an agreed action plan to reduce mortality from elective AAA repair through a quality improvement framework consisting of best practice standards for aortic surgery, the 30-day mortality after elective AAA surgery improved to 2.4%. It is imperative that the low mortality be maintained so that AAA screening will continue to be effective. In this issue, Linne et al. compared postoperative mortality and morbidity between patients with screendetected versus nonscreen-detected AAAs. They reported low postoperative mortality after AAA surgery and their data revealed no differences in postoperative mortality (at 30 days, 90 days, and 1 year) or morbidity between patients with screen-detected AAAs and agematched controls. The effectiveness of AAA screening is clearly dependent on the safe management of any AAA detected, and the low postoperative mortality and morbidity in screen-detected AAA patients from the Swedish National Registry for Vascular Surgery (Swedvasc) are therefore very encouraging. Linne et al. postulated that nonscreen-detected male patients with AAA will have more comorbidities that those detected through screening. Intuitively, this would seem reasonable, and Linne et al. suggested that nonscreened patients are more likely to be demographically