Screening for Abdominal Aortic Aneurysm During Transthoracic Echocardiography: A Systematic Review and Meta-analysis

Christos Argyriou; George S Georgiadis; Nikolaos Kontopodis; Arun D Pherwani; Joost A Van Herwaarden; Constantijn E V B Hazenberg; George A Antoniou

doi:10.1016/j.ejvs.2018.01.003

Screening for Abdominal Aortic Aneurysm During Transthoracic Echocardiography: A Systematic Review and Meta-analysis

Eur J Vasc Endovasc Surg. 2018 Apr;55(4):475-491. doi: 10.1016/j.ejvs.2018.01.003. Epub 2018 Feb 9.

Authors

Christos Argyriou¹, George S Georgiadis², Nikolaos Kontopodis³, Arun D Pherwani¹, Joost A Van Herwaarden⁴, Constantijn E V B Hazenberg⁴, George A Antoniou⁵

Affiliations

¹ Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK.
² Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece. Electronic address: ggeorgia@med.duth.gr.
³ Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece.
⁴ Department of Vascular Surgery, University Medical Centre, Utrecht, The Netherlands.
⁵ Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK.

PMID: 29433798
DOI: 10.1016/j.ejvs.2018.01.003

Abstract

Background: Screening for abdominal aortic aneurysm (AAA) during transthoracic echocardiography (TTE) may be an effective targeted screening strategy.

Objective: The aim was to assess the feasibility of AAA screening during TTE and to estimate the prevalence of AAA in patients undergoing TTE.

Methods: Electronic bibliographic sources were interrogated using a combination of free text and controlled vocabulary searches to identify studies reporting on AAA screening during TTE. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. Fixed effect or random effects models were used to calculate pooled prevalence estimates.

Results: Twenty observational cohort studies were identified reporting a total of 43,341 participants (23,291 men and 20,050 women). Hypertension was reported in 41% (95% CI 38-43), hypercholesterolemia in 31% (95% CI 29-32), diabetes mellitus in 20% (95% CI 19-22), and tobacco use in 37% (95% CI 35-38). The aorta was visualised in 86% (95% CI 84-88) of the screened population. The pooled prevalence of AAA in the entire screened population was 0.033 (95% CI 0.024-0.044). The pooled prevalence of AAA in men was 0.046 (95% CI 0.032-0.065) and in women it was 0.014 (95% CI 0.008-0.022). The mean age of participants in whom an AAA was detected ranged across the studies from 66 to 85 years. The mean diameter of the aneurysm identified ranged across the studies from 35 mm to 45 mm. Clinical outcomes in participants with a detected AAA were poorly reported.

Conclusions: Screening for AAA during TTE may identify a population group with a high risk of AAA in whom targeted screening may be beneficial. Further research is required to investigate the cost-effectiveness and clinical benefits of AAA screening in this setting.

Keywords: Abdominal aortic aneurysm; Echocardiogram; Screening; Transthoracic echocardiography; Ultrasound.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Aortic Aneurysm, Abdominal / diagnostic imaging*
Diabetes Mellitus / epidemiology
Echocardiography*
Humans
Hypercholesterolemia / epidemiology
Hypertension / epidemiology
Mass Screening
Risk Factors
Smoking / epidemiology