Increased prevalence of abdominal aortic aneurysm in patients undergoing inguinal hernia repair compared with patients without hernia receiving aneurysm screening

Abstract

The introduction of screening programs for abdominal aortic aneurysm (AAA) is being contemplated by health services in several countries. The correlation between aortic aneurysm and abdominal wall hernias is well reported, and inguinal hernia has been identified as a risk factor for aortic aneurysm. However, the prevalence of AAA in patients with inguinal hernia has not been adequately documented. This study evaluated whether patients with inguinal hernia are at increased risk of having an AAA compared with patients without hernia receiving aneurysm screening. Men aged >55 undergoing primary inguinal hernia repair underwent ultrasound imaging of the abdominal aorta to screen for aneurysm. A reference group was selected from men without clinical evidence of inguinal hernia participating in an AAA screening program. Prevalence and odds ratios of AAA in the two groups were calculated. The study cohort comprised 235 patients with inguinal hernia and 203 controls. The mean ± SD aortic diameter was 22 ± 9 mm in patients with inguinal hernia vs 20 ± 6 mm for controls (P = .045). The prevalence of AAA was 8.1% in the hernia group and 3.9% in the control group (adjusted odds ratio, 3.9; 95% confidence interval, 1.6-9.5; P = .039). For aneurysms >4 cm, the prevalence was 5.1% in those with an inguinal hernia and 1.5% in those without an inguinal hernia (adjusted odds ratio, 4.7; 95% confidence interval, 1.2-18.5, P = .025). Inguinal hernia was a significant risk factor for AAA. Entry into a screening program of men aged >55 admitted for inguinal hernia repair should be considered.