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Aneurysms & Aneurysm Screening

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Presentation on theme: "Aneurysms & Aneurysm Screening"— Presentation transcript:

1 Aneurysms & Aneurysm Screening
Mr Marcus Cleanthis Consultant Vascular Surgeon Frimley Park Hospital

2 Aortic Aneurysms Most common in men over 65 who smoke and are hypertensive Are treated when above 5.5 cm Can be treated by open surgery or stenting

3 Abdominal Aortic Aneurysms
Aorta larger than 1.5 times its normal diameter Or aorta exceeds 3 cm in

4 Clinical findings Examination picks up only % of AAA False positive diagnosis in thin individuals Low accuracy for size estimation 60% found on radiological imaging a fifth of them not palpable on examination

5 Clinical Presentation
Most are asymptomatic, found on scanning or examination Back pain Abdominal pain ( suspect inflammatory aneurysm) Distal embolisation Aneurysm thrombosis ( rare) Primary aorto-duodenal fistula ( rare)

6 Mis-Diagnosis Initial Diagnosis Misdiagnosed Cases, % Average Delay, h
Renal colic 24 15 Diverticulitis 13 79 GI hemorrhage 17 Acute MI 8.7 Back pain 18 Motor vehicle accident 6.5 1.5 Sepsis 26 Other GI problem 4 Other/no diagnosis

7 Rupture risk <40mm <1% per yr 40-55mm 1% per yr 55-79mm 10% per yr >70mm 25% per yr Risk factors for rupture Larger size >55mm Rapid expansion >10mm/yr Hypertension Smoking COPD Female sex

8 Treatments Open Surgical Repair EndoVascular Aneurysm Repair (EVAR)


10 Open aneurysm treatment

Minimal invasive aortic aneurysm repair through an endoluminal approach via a remote artery.

12 Endovascular Aneurysm Repair
Minimally invasive Reduced morbidity Reduced mortality Less post-op pain No/minimal ITU/HDU Reduced hospital stay

13 Endovascular Aneurysm Repair Technique

14 Cook Zenith Stentgraft

15 Aorto-uni-iliac Graft


17 EVAR I Trial 30-day mortality EVAR I 1.7%

5.0cm? 5.5cm? 6.0cm? UK Small Aneurysm Trial


20 UK Small Aneurysm Trial
1090 patients, Aged 60-76years, Fit Asymptomatic 4.0 – 5.5cm AAA Randomised: Early Surgery/Surveillance Mean FU 4.6years Statistical analysis: Intention to Treat Primary endpoint: death

21 UK Small Aneurysm Trial

22 UK Small Aneurysm Trial
No difference in mortality in two groups Cost analysis: surveillance cheaper Conclusion: AAA <5.5cm should be managed conservatively

23 Aneurysm Screening

24 UK AAA Screening Men aged 65 and over are eligible for AAA screening
The NHS invites men for AAA screening during the year they turn 65 Men over 65 who have not been screened previously can arrange a screening appointment by contacting their local programme directly Screening involves an ultrasound scan that takes around 10 minutes The NHS AAA Screening Programme aims to reduce deaths from ruptured AAA amongst men aged 65 and over by up to 50%

25 Gloucestershire Aneurysm Screening
25,000 ultrasound invitations 85% attendance Costs approx. £10 per scan 99% imaging success 1% of aortas >4cm diameter

26 Gloucestershire Aneurysm Screening
Most rupture occurred in the 15% of patients who DNA’d Incidence of aneurysm rupture in the screened group reduced by 85% (Scott et al Br J Surg 1995)


28 MASS Results 80% of screened group accepted invitations
1333 aneurysms detected 65 aneurysm-related deaths invited group 113 aneurysm related deaths control group 42% risk reduction in invited group 53% risk reduction in those screened Elective mortality 6% Emergency surgery mortality 37%

29 MASS Results

30 Summary Treatment for AAA : greater than 5.5cm growth 1.0cm /12months
Tender AAA (inflammatory….) Rupture AAA

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