The Abdominal Aortic Aneurysm – Prognosis, Treatment, Screening and Cost-Effectiveness

Abstract

Mass screening is claimed for finding a disease in which symptoms are not yet occurred. The indication for such an examination is given if the early detection of the disease allows treatment with lower morbidity and mortality than treatment at an advanced stage. In addition, the long-term prognosis of the patients must be considered. Screening makes only sense if the overall mortality of a specific population can be diminished by the diagnostic and therapeutic measures. In assessing the screening for an asymptomatic abdominal aortic aneurysm (AAA) that has to be treated surgically to avoid the rupture of the AAA with its associated high fatality rate, the expected extension of life should be weighed against the risk of surgery. It must be ensured that the untreated disease would progress to rupture of the AAA with fatal outcome. The benefits of screening and subsequent prophylactic operation must be contrasted its risk and cost. It is the objective of the following remarks to outline the value of screening for AAA on the basis of studies on the prevalence of AAA, risk of rupture, and the results of surgical treatment. Meanwhile, two different approaches are available for the treatment of AAA, open repair and endovascular aneurysm repair (EVAR). The considerations for prophylactic repair of AAA must therefore also include morbidity and mortality of the two interventions and the evaluation of cost-benefit ratio. This will be shown in the following.