Abdominal Aortic Aneurysm – Different Aspects on Screening
Abstract Abdominal aortic aneurysm (AAA) is a hideous life threatening disease that most often is asymptomatic until it ruptures. Ruptured abdominal aortic aneurysm (rAAA) is a painful and serious predicament with a mortality of 80-90%. Half of the patients die before arriving to hospital, leaving family members in sorrow and shock. In Sweden about 700-1000 patients die each year due to rAAA, corresponding to 1.5% of all deaths in men. Four randomized trials have shown that screening for AAA is cost-effective to reduce both AAA related mortality by 50% and all-cause mortality by 3%. These trials have been the reason why screening 65 year-old-men for AAA has been introduced in Sweden. In this thesis we evaluated different aspects on screening for AAA. Study I; the aim was to study whether a biological marker (APC PCI complex) may be used as a screening marker for AAA in patients with peripheral vascular disease without previously known AAA. However, the sensitivity and specificity were both to weak to be used as a screening marker for AAA in the clinical praxis. Nevertheless, we discovered that the prevalence of AAA was 13% in patients with peripheral vascular disease. Study II; the aim was to investigate the impact of socioeconomic status (SES) and demographical aspects on compliance to AAA- screening and also to evaluate the associations between AAA prevalence and SES. Our results indicated that the prevalence of AAA is higher in demographic areas with lower SES. The compliance to AAA-screening was also lower in areas with lower SES. Study III; the aim was to investigate if a collaboration between a professional advertising agency and an academic vascular unit can result in increased compliance to AAA screening. The results showed that compliance to AAA-screening can be increased significantly by consulting an advertisng agency. Study III; the aim was to evaluate if screening is still cost-effectivley in the new era of decreased AAA prevalence, EVAR as the predominant treatment method and improved medical treatment. By using a Markov model we could show that it is still cost-effective to screen for AAA even with the aformentioned changes. In conclusion; Screening for AAA seems justified in the new era of changing prerequisites. However, importance of SES and different aspects on improving AAA compliance are of great importance and need to be studied further.
Surgery, Abdominal aortic aneurysm, screening, biomarkers, socioeconomic status
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Unit for Clinical Vascular Disease Research