Six-year Experience of the Northern Ireland AAA Screening Program

Abstract

Introduction: Perioperative mortality for elective AAA patients has significantly improved over the last 20 years. Unfortunately ruptured AAA remains a significant mortality risk. The Northern Ireland AAA Screening Programme was introduced in 2012 with the primary objective to reduce AAA rupture rates through early detection and expedited procedural intervention of 65-year old male patients. The aim of this study was to review the 6 year experience of the NI AAA Screening Programme. Methods: This study analysed prospective data from the NI AAA Screening Programme from 2012 to 2017 including population demographics, AAA detection rates and procedural intervention. Patients with screen detected AAA above 5.5cm were considered for referral for vascular intervention while AAA less than 5.5cm were enrolled in AAA surveillance. Results: 56631 male patients were invited to participate. A further 3178 patients self-referred for AAA screening. 84.2% of invited patients proceeded to AAA screening. An annual prevalence rate between 1.3% and 1.7% has been reported for invited patients compared to 2.3% in self-referred patients. 110 patients above threshold for intervention have been referred to the regional vascular surgery centre whilst 549 remain under surveillance (Table 1). To date, 101 patients have proceeded to intervention including 57 open AAA repair and 44 endovascular patients. Conclusion: The NI AAA screening program has proven to be very successful with an uptake of nearly 85% of invited male patients. Although our AAA detection rate is lower than the 4.7% reported in the original Multicentre Aneurysm Screening Study, it still remains cost effective with a greater than 0.35% AAA prevalence.Tabled 12012–132013–142014–152015–162016–172017–18Self-referrals and pre-prog transfersOverallAAAs detected- Referrals made263216128412110- Currently on surveillance648088103847456549AAAs detected, now discharged- Decreased141364––239- Declined/DNA–––21––3- Out of cohort–discharged19761034241Totals113132116131968272742 Open table in a new tab