Detection of Abdominal Aortic Aneurysms

Alan G. Lossing, MD, FRCSC, Marjorie A. Burnett, Hons. BSc, Andrew Dueck, MD.
St Michael's Hospital, Toronto, ON, Canada.

Introduction: Despite much lower mortality rates following elective repair compared to repair for ruptured or even symptomatic abdominal aortic aneurysms (AAAs), a well accepted screening program is yet to be described in Canada. We sought to describe how AAAs are typically discovered.
Methods: Retrospective consecutive case series.
Results: There were 203 consecutive patients enrolled in the study, 82.2% of whom were men. Screening accounted for the discovery of only 9 (4.4%) AAAs. Abdominal aortic aneurysms were detected due to symptoms in 45 patients (22.2%), 34 (16.7%) due to rupture, on routine physical exam in 25 (12.3%), during work up for malignancy in 23 (11.3%), genitourinary pathology in 17 (8.4%) or for other medical conditions in 50 (24.6%). A total of 38.9% (ruptures/symptoms) of patients developed complications of aneurysmal disease before detection. The in-hospital mortality was 3.9% following elective repair, and 42.4% following rupture.
Conclusion: Ninety six percent of this patient population's AAA was detected by chance. More aggressive screening programs are urgently needed to lower overall morbidity and mortality for patients with abdominal aortic aneurysms. Despite reduction in mortality if aneurysms are repaired before they rupture or become symptomatic, 38.9% of patients developed these complications before their AAAs are discovered.

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