Aneurysm Screening Research Articles

Screening for Abdominal Aortic Aneurysms Still Prevents Ruptures: A Secondary Analysis of the VIVA Trial.

Screening for Abdominal Aortic Aneurysms Still Prevents Ruptures: A Secondary Analysis of the VIVA Trial.

Ascending thoracic aortic aneurysm screening intervals and rates of expansion: a growing body of literature

Ascending thoracic aortic aneurysm screening intervals and rates of expansion: a growing body of literature

Systematic review of clinical effectiveness and safety of abdominal aortic aneurysm screening in men

Abstract Background Abdominal aortic aneurysm (AAA) is characterised by a bulging in the aortic wall. AAA is typically asymptomatic until aneurysm rupture, which is associated with a very high mortality rate (approximately 80%). In the context of an ageing population and increasing life expectancy, innovative approaches to early detection and intervention are needed. The aim of this review was to assess the clinical effectiveness and safety of one-time ultrasound screening for AAA in men. Methods Systematic searches were conducted in electronic databases and grey literature sources. The primary outcomes of interest were AAA-related mortality, AAA rupture, all-cause mortality, rate of surgical repair and safety. The following study designs were included: systematic reviews, randomised controlled trials (RCTs), comparative observational studies and population-based non-comparative observational studies. Results Results from a systematic review by the US Preventive Services Task Force analysed 4 population-based RCTs, showing that one-time population-based screening for AAA in men (≥ 65 years) led to significant reductions in AAA-related mortality (OR = 0.65, 95% CI: 0.57 to 0.74), AAA rupture (OR = 0.61, 95% CI: 0.54 to 0.69) and emergency surgeries (OR = 0.53, 95% CI: 95% CI: 0.44 to 0.64) at 13-15 years follow-up, relative to no screening. Separate to this systematic review an additional 24 studies reported on clinical effectiveness, safety and psychosocial harms of AAA screening. Limited evidence from these studies suggest screening was associated with a reduction in AAA-related mortality and rupture but also transient psychological distress in some cases. Conclusions One-time ultrasound screening in men ≥65 years appears to offer benefits in terms of reducing AAA ruptures and AAA-related mortality, though the balance of benefits and harms requires careful consideration. In an ageing population, AAA screening could be transformative, by reducing mortality and rupture risks. Key messages • One-time ultrasound screening for AAA in older men (≥ 65 years) can reduce AAA-related mortality and rupture. • In the context of an ageing population in Europe, AAA screening could be transformative, but benefits must be weighed against potential risks.

What are the pros and cons of a nationwide abdominal aortic aneurysm screening programme?

What are the pros and cons of a nationwide abdominal aortic aneurysm screening programme?

Optimising Abdominal Aortic Aneurysm Screening of 65 Year Old Men by Exploring Risk Factor Based Targeted Screening Strategies in Light of Declining Prevalence of the Disease

A decline in abdominal aortic aneurysm (AAA) prevalence calls into question the credibility of general population screening of 65 year old men. Selectively targeting high risk individuals among this group could be more effective in preventing death from AAA rupture. This cross sectional study analysed risk factor data in a cohort of 65 year old men screened in the Swedish general population based AAA screening program, with the aim of exploring the effectiveness of hypothetical targeted screening strategies. All men attending AAA screening in four neighbouring counties in Sweden between 2006 and 2010 completed a health questionnaire on smoking habits and medical history. Abdominal aortic aneurysm was defined as measuring ≥ 30 mm. The sensitivity and specificity of different targeted screening strategies, with targeted subpopulations defined by duration of smoking with and without additional risk factors, were explored using receiver operating characteristic (ROC) curves. A total of 16 232 men were screened, with 236 (1.5%) screening detected AAAs. A strategy combining smoking, presence of coronary artery disease (CAD), or both was associated with the mathematically optimal balance between sensitivity and specificity (optimal threshold) in the ROC analysis. The optimal threshold corresponded to targeting men having smoked for thirty years or more, a history of CAD, or both, where 74.0% of all AAAs could be detected by screening 33.0% of the population, compared with general screening. Targeting men that have smoked for ten years or more indicated that 84.0% of all AAAs could be detected by screening 55.0% of the population. A simplified strategy of targeting ever smokers resulted in detecting 85.0% of all AAAs by screening 61.0% of the population. Targeted screening of men at high risk of AAA, focusing on smoking history for inclusion, may be a safe and effective alternative to general population screening.

Automated Analysis of Thoracic Aortic Aneurysms Based on Chest Computed Tomography Data: a Population Study in Moscow

Background. Cardiovascular diseases remain a pressing issue associated with great economic burden and loss of earning capacity. Among them, thoracic aortic aneurysms pose a serious threat as they commonly develop asymptomatically. Patients with aneurysms are often diagnosed late, which contributes to higher mortality rates due to complications. For this reason, conducting new epidemiological studies on this problem in our country is relevant.Objective: to study the prevalence of pathological dilatation of the thoracic aorta in Moscow by means of artificial intelligence technologies (AITs) using chest computed tomography (CT) data.Material and methods. A retrospective analysis of chest CT data from 227,149 patients obtained in the period from October 2022 to October 2023 was performed using AITs.Results. The analysis revealed that 13.3% of patients exhibited signs of thoracic aortic dilatation, while 0.8% had aneurysm signs. The prevalence of thoracic aortic aneurysms in Moscow was 12.4 cases per 100,000 individuals. Males were more susceptible than females; aneurysms of the descending aorta were more typical for them, while aneurysms of the ascending aorta were more common in females. The incidence of thoracic aortic dilatation increased with age. Potential causes and strategies to minimize AIT errors were discussed.Conclusion. The results highlight the importance of opportunistic screening for thoracic aortic aneurysms to ensure timely detection and prevention of complications. It would be especially beneficial to men and elderly population. The effectiveness of AITs to support decision-making by radiologists analyzing chest CT results was confirmed. The study provides an important update to the data on the prevalence of thoracic aortic aneurysms in asymptomatic patients in Russia. The identified features make it possible to direct the diagnostic and prevention efforts more effectively.

Whole aorta imaging shows increased risk for thoracic aortic aneurysms and dilatations in relatives of abdominal aortic aneurysm patients

ObjectiveFor relatives of abdominal aortic aneurysm (AAA) patients, guidelines recommend abdominal imaging aimed at early detection and management of AAA, and do not include screening for thoracic aortic aneurysms (TAA). We aimed to investigate if TAA occur in undiagnosed relatives of AAA patients without a known genetic susceptibility for aneurysms, similar to families with identified genetic susceptibilities for aneurysms like in Marfan and Loeys-Dietz syndrome, where both AAA and TAA occur. MethodsRelatives of AAA patients were invited for non-contrast whole aorta CT screening. Systematic measurements of the CT scans were used to detect aneurysms and dilatations. Classification into familial and non-familial was based on reported family histories. In addition, aneurysm gene panel testing of AAA index cases was used for the classification of high vs unknown genetic risk (high genetic risk: familial aneurysm or a (likely) pathogenic variant (P/LP) in an aneurysm gene; unknown genetic risk: no family history or P/LP). ResultsWhole aorta imaging of 301 relatives of 115 abdominal aortic aneurysm index-patients with non-contrast CT scans showed a 28-fold increase in thoracic aortic aneurysms in relatives (1.7%, p<0.001 versus the age adjusted population) and a high frequency of thoracic dilatations in 18% of the relatives. Thoracic aneurysms and dilatations in relatives occurred even when index patients were unaware of familial aneurysms. AAA was increased in the relatives compared to the age adjusted population (8%, p<0.001). ConclusionsAn increased risk for thoracic aneurysms and dilatations was detected by whole aorta imaging of relatives of AAA index patients, even when index patients were unaware of familial aneurysms.These results indicate -still unknown- shared genetic susceptibilities for thoracic and abdominal aneurysms. Therefore, imaging of the whole aorta of relatives of all abdominal aneurysm patients, will improve early detection of aortic aneurysms in relatives of all AAA patients.

Clinical and financial impact of a machine learning powered screening program for abdominal aortic aneurysms

ObjectiveOur health system recently implemented a machine learning (ML)-enhanced abdominal aortic aneurysm (AAA) screening program to identify and screen high-risk individuals. This program, which uses clinical data to identify the top 150 high-risk patients monthly, increased the number of AAA screening ultrasound examinations and positive diagnoses. The aim of this study was to quantify the clinical and financial impacts of a ML-enhanced AAA screening program in terms of lives saved, costs incurred, payments received, and incremental cost-effectiveness ratio. MethodsWe compared 900 high-risk individuals identified from February to July 2023 (intervention cohort) with 900 individuals from February to July 2022 (comparison cohort), assessing screening rates, positive diagnoses, and outcomes using both internal electronic health record data and external research statistics for long-term estimates. ResultsThis analysis demonstrated a 590% increase in AAA screening within the intervention cohort and a 238% increase in positive AAA diagnoses. The program decreased expected AAA deaths by 36%, primarily by increasing elective surgeries and decreasing emergency repairs. Financial analysis revealed an increase in costs and payments, improving hospital net income and return on investment. The incremental cost-effectiveness ratio of $5222 per quality-adjusted life year) compares favorably with other well-accepted screening initiatives. ConclusionsOverall, an ML-enhanced AAA screening program improves clinical outcomes and financial performance, demonstrating cost effectiveness and feasibility. Future research will refine these estimates and explore similar ML-based risk stratification programs for other conditions.

Genetic Mutation Type and Cerebral Aneurysm Screening in Patients with ADPKD

Genetic Mutation Type and Cerebral Aneurysm Screening in Patients with ADPKD

Identifying markers of health-seeking behaviour and healthcare access in UK electronic health records

ObjectiveTo assess the feasibility of identifying markers of health-seeking behaviour and healthcare access in UK electronic health records (EHR), for identifying populations at risk of poor health outcomes and adjusting...

Advancements in opportunistic intracranial aneurysm screening: The impact of a deep learning algorithm on radiologists' analysis of T2-weighted cranial MRI

(1) Background: Unruptured Intracranial Aneurysms (UIAs) are common blood vessel malformations, occurring in up to 3 % of healthy adults. Magnetic Resonance Angiography (MRA) is frequently used for the screening of UIAs due to its high resolution in vascular anatomy. However, T2-Weighted Magnetic Resonance Imaging (T2WI) is a standard sequence utilized for the majority of outpatient head scans. By employing a sequence such as T2WI, there is a possible shift towards early detection of UIAs through opportunistic screening. Here, we assess a Deep Learning Algorithm (DLA) developed to assist radiologists in identifying and reporting UIAs on T2WI in a routine clinical setting. (2) Methods: A DLA was trained on a set of 110 patients undergoing an MR head scan with the gold standard set by two radiology experts. Eight radiologists were given a cohort of 50 cranial T2WI studies and asked for a routine report. After a 10-day washout period, they reviewed the same cases randomized and supported by the DLA predictions. We assessed changes in sensitivity, specificity, accuracy, and false positives. (3) Results: During routine reporting, the models’ assistance improved the sensitivity of the eight participants by an average of 36.19 and the accuracy by 10.00 percentage points. (4) Conclusion: Our results indicate the potential benefit of deep learning to improve radiologists' detection of UIAs during routine reporting. From this, we can infer that the combination of T2WI with our DLA supports opportunistic screening, suggesting potential approaches for future research and application.

Evaluating the cost-effectiveness of polygenic risk score-stratified screening for abdominal aortic aneurysm

As the heritability of abdominal aortic aneurysm (AAA) is high and AAA partially shares genetic architecture with other cardiovascular diseases, genetic information could help inform AAA screening strategies. Exploiting pleiotropy and meta-analysing summary data from large studies, we construct a polygenic risk score (PRS) for AAA. Leveraging related traits improves PRS performance (R2) by 22.7%, relative to using AAA alone. Compared with the low PRS tertile, intermediate and high tertiles have hazard ratios for AAA of 2.13 (95%CI 1.61, 2.82) and 3.70 (95%CI 2.86, 4.80) respectively, adjusted for clinical risk factors. Using simulation modelling, we compare PRS- and smoking-stratified screening with inviting men at age 65 and not inviting women (current UK strategy). In a futuristic scenario where genomic information is available, our modelling suggests inviting male current smokers with high PRS earlier than 65 and screening female smokers with high/intermediate PRS at 65 and 70 respectively, may improve cost-effectiveness.

Screening for abdominal aortic aneurysm in the world and in Russia

Despite the global trend towards a decrease in the prevalence of abdominal aortic aneurysm (AAA), this disease remains one of the sudden death causes in the elderly. This necessitates the need to conduct screening studies, the effectiveness and feasibility of which has been proven in large studies, including population-based ones, and meta-analyses. The traditional and most optimal screening method is ultrasound examination. According to the guidelines of different countries, the indications for abdominal aorta ultrasound vary. Today in Russia there is no accurate data on the prevalence of AAA, while the target group for screening has not been defined, and therefore the country needs to conduct large population studies to study its prevalence and risk factors, as well as to calculate indicators of the clinical and economic effectiveness of implementation AAA screening programs.

72315 - Point Of Care Ultrasound (POCUS) in screening for Abdominal Aortic Aneurysm: a comparative, cohort study

72315 - Point Of Care Ultrasound (POCUS) in screening for Abdominal Aortic Aneurysm: a comparative, cohort study

Additional Relevant Intracranial Findings in Persons Screened with MR for Intracranial Aneurysms

BackgroundRadiological screening for intracranial aneurysms (IAs) may identify other relevant intracranial findings. We investigated their prevalence on MR in persons screened for IAs. MethodsWe included all persons who were screened for the presence of IAs with brain MRI/MRA between 1996 and 2022 because of a family history of aneurysmal subarachnoid haemorrhage (aSAH) or autosomal dominant polycystic kidney disease (ADPKD). We reviewed radiology reports of initial and repeated brain MR to identify additional intracranial findings that needed follow-up or treatment, or carried a risk of becoming symptomatic. ResultsWe included 766 persons (positive family history of aSAH: n = 681; ADPKD: n = 85) who had 1446 MRI/MRAs. At initial screening, 49 additional relevant intracranial findings were reported in 47 persons (6.1%, 95% CI 4.7–8.1%). Of all included persons, 338 (44%) underwent one (n = 154) or more (n = 184) follow-up screenings (total MRI/MRAs at follow-up: n = 680). In 15/338 persons (4.4%, 95% CI 2.7–7.2%), 16 new additional relevant findings were reported at a median follow-up duration of 10 years (IQR 5–12). ConclusionsPersons who are counselled for screening for IAs should be informed that there is a six percent chance of identifying an additional finding that requires follow-up or treatment, or may become symptomatic. Additionally, after 10-year follow-up screening there is a four percent chance of identifying a new additional relevant finding. The impact of such findings on quality of life needs further study.

Polygenic Risk Score Informed Clinical Model for Improving Abdominal Aortic Aneurysm Screening

Abdominal aortic aneurysm (AAA) is a complex disease with environmental and genetic risk factors. Polygenic risk scores (PRSs) based on disease-specific risk-associated single nucleotide variants (SNVs) have demonstrated effectiveness in stratifying individual-level disease risk for cardiovascular diseases. This prospective cohort study assessed associations of PRS of AAA (PRSAAA) with risk of incident AAA, analyzed the effectiveness of a combined clinical-genetic risk model, and explored the clinical utility of the model in identifying high-risk individuals for AAA screening. PRSAAA was calculated using 911,440 SNVs and PRS of coronary artery disease was calculated using 2,324,683 SNVs derived from mixed ancestry genome-wide association studies. The UK Biobank was used as the study cohort. All individuals with complete genetic data available and no diagnosis of AAA at the time of recruitment were included in the analysis and followed prospectively to assess for incident AAA. A PRS-informed clinical model, Prob-AAA, was developed using clinically significant variables and PRSAAA. Four hundred eighty-one thousand one hundred 5 individuals were included in the analysis with 2,668 incident AAA cases. Incident AAA increased from 0.30 to 0.93% between the lowest and highest decile of PRSAAA; similarly, severe AAA, requiring surgery and/or presenting with rupture, increased from 23 to 39% of incident AAA cases across deciles. PRSAAA was a predictor of incident AAA diagnosis (hazard ratio 2.06 [1.70-2.48]) independent of other clinical risk factors including male sex, older age, and smoking history. Prob-AAA was an independent predictor of incident AAA (hazard ratio 1.92 [1.69-2.20]), and identified 9.6% of cases of incident AAA compared to only 4.2% by PRSAAA. Current screening guidelines captured 5.7% of the overall cohort, with an incident AAA rate of approximately 3.2%. Among males not included by current guidelines, Prob-AAA identified an additional cohort, approximately 2% of the overall cohort, with a similar rate of incident AAA. Prob-AAA, a PRS-informed clinical model for AAA, improved upon the predictive power of current, clinical risk factor-informed, screening guidelines for AAA.

Causal association between Neuroticism and risk of aortic aneurysm: A bidirectional two-sample Mendelian randomization study

BackgroundThe objective of this study was to analyze the causal relationship between Neuroticism and aortic aneurysm using Mendelian randomization (MR). The study aimed to establish a foundation for the development of effective prevention and treatment strategies. MethodsGenetic association data for Neuroticism were obtained from the UK Biobank, which included 393,411 individuals and 11,968,760 single nucleotide polymorphisms (SNPs). Genetic association data for aortic aneurysm were obtained from a genome-wide association study (GWAS), which included 479,194 individuals and 24,191,825 SNPs. Heterogeneity was assessed using the Cochran's Q statistic test. The study also utilized the MR Pleiotropy RESidual Sum and Outlier (Mr-PRESSO) test, as well as the MR-Egger regression method, to examine horizontal pleiotropy and determine the reliability of the findings through the leave-one-out method. ResultsForward MR analysis showed that the risk of aortic aneurysm was elevated in individuals with genetically predicted Neuroticism compared to those without Neuroticism (OR = 1.1315, 95 % CI: 1.0269–1.2468; P = 0.0126). The Cochran's Q test showed no heterogeneity (P > 0.05), and the MR-PRESSO test did not identify instrumental variables of horizontal pleiotropy (P > 0.05). The MR analysis remained robust after removing SNPs one by one. Inverse MR analysis did not observe an association between aortic aneurysm and having Neuroticism OR = 1.030, 95 % CI: 0.9459–1.118, P = 0.488). ConclusionOur study has established a clear causal relationship between genetically determined Neuroticism and the development of aortic aneurysms. It is therefore important to intensify screening and prevention efforts for aortic aneurysms in neurotic patients. It also opens new avenues for exploring the disease's pathogenesis.

Ultrasound screening for abdominal aortic aneurysm in primary care

IntroductionAbdominal aortic aneurysm (AAA) constitutes a pathology with high mortality. There is currently no screening program implemented in Primary care in Spain. ObjectivesTo evaluate the usefulness of ultrasound in the detection of AAA in the at-risk population in Primary care. Secondarily, to identify subjects whose vascular risk (VR) should be reclassified and to determine whether AAA is associated with the presence of carotid plaque and other risk factors. Material and methodsCross-sectional, descriptive, multicenter, national, descriptive study in Primary care. Subjects: A consecutive selection of hypertensive males aged between 65 and 75 who are either smokers or former smokers, or individuals over the age of 50 of both sexes with a family history of AAA. MeasurementsDiameter of abdominal aorta and iliac arteries; detection of abdominal aortic and carotid atherosclerotic plaque. VR was calculated at the beginning and after testing (SCORE). Results150 patients were analyzed (age: 68.3 ± 5 years; 89.3% male). Baseline RV was high/very high in 55.3%. AAA was detected in 12 patients (8%; 95%CI: 4–12); aortic ectasia in 13 (8.7%); abdominal aortic plaque in 44% and carotid plaque in 62% of the participants. VR was reclassified in 50% of subjects. The detection of AAA or ectasia was associated with the presence of carotid plaque, current smoking and lipoprotein(a), p < 0.01. ConclusionsThe prevalence of AAA in patients with VR is high. Ultrasound in Primary care allows detection of AAA and subclinical atherosclerosis and consequently reclassification of the VR, demonstrating its utility in screening for AAA in the at-risk population.

Thirty-Nine Percent of Patients with a Ruptured Abdominal Aortic Aneurysm (AAA) Have an Incidentally Detected AAA Prior to Rupture

IntroductionAbdominal aortic aneurysm (AAA) screening has been offered to 65-year-old men living in Oslo, Norway, since May 2011. A significant number of AAA-related deaths occurred in individuals who are not eligible for screening. The primary aim of this study was to describe the group of patients admitted to Oslo University Hospital with a ruptured AAA after the implementation of the local AAA screening project. The following parameters were investigated: AAA detection prior to rupture, surveillance status, eligibility for screening and comorbidities. We also sought to compare outcomes (repair rates and 30-day mortality) between patients with and without an AAA detected prior to rupture. MethodsThis cohort study included patients admitted acutely to Oslo University Hospital due to a symptomatic or ruptured AAA in the period January 2011 to December 2022. Data on demographics, prior AAA detection, surveillance status, treatment and mortality were collected retrospectively through electronic medical records. ResultsWe identified 200 patients with a symptomatic or ruptured AAA, among which 79 (40%) had an AAA detected prior to rupture – one (1%) through screening and 78 (39%) incidentally. Up to 30% of the incidentally detected AAAs were not under any surveillance. Six patients were found eligible for screening: one had attended, three were non-attenders and two had not been invited. Patients with an incidentally detected AAA prior to rupture had a more advanced age and a significantly higher degree of comorbidities than patients without a previously detected AAA, and the repair rates in these groups were 56% and 84% respectively (p < 0.001). Adjusted for comorbidities and risk factors, the odds ratio for repair among patients with incidentally detected AAA was 0.56 (p = 0.292). The 30-day mortality was not significantly different between the two groups (p = 0.097). ConclusionMost patients with a ruptured AAA were not eligible for screening, but 39% of the patients had an incidentally detected AAA prior to rupture. Standardized reporting and follow-up of incidentally detected AAAs is thus identified as an additional measure to organized screening in the effort to reduce AAA-related mortality.

Abdominal Aortic Aneurysm Screening and Surveillance – can we do better? A QI Project

Abdominal Aortic Aneurysm Screening and Surveillance – can we do better? A QI Project