Epidemiology Study of Fatal Ruptured Aortic Aneurysms Suggests Need for Expanding Screening Guidelines

 

February 20, 2019—The Society for Vascular Surgery announced the publication of a study showing that a significant number of deaths from ruptured aortic aneurysms occur in patients whose demographics exclude them from screening guidelines.

The study demonstrated that although the number of deaths caused by ruptured aortic aneurysms has decreased 68% in recent years, a significant number of deaths from ruptured aortic aneurysms occur in patients whose demographics exclude them from screening guidelines. Specifically, 34% of deaths occurred in women and 9% occurred in men < 65 years, whereas screening guidelines recommend screening men ≥ 65 years who have either smoked or have a first degree relative with an aortic aneurysm.

The findings were published by Halah Abdulameer, MD, et al in Journal of Vascular Surgery (2019;69:378–384). The study investigators were led by Ross Milner, MD, who is Professor of Surgery and Codirector of the Center for Aortic Diseases at The University of Chicago Medicine in Chicago, Illinois.

In the SVS announcement, Dr. Milner commented, “The reason for this significant decrease in mortality due to ruptured aortic aneurysm remains speculative, but is likely multifactorial, including risk factor modification, population screening, improvement in regional centralization, adequate emergency preparedness, and improvement in surgical care.”

SVS noted that significant attention has been given to ruptured aortic aneurysm in the form of risk factor modification, screening programs, and endovascular therapy for ruptures. Ruptured aortic aneurysm has very high mortality and is currently the 15th leading cause of death in men older than 65 years.

As reported by SVS, the investigators performed a retrospective review of the national death certificate data from the United States National Vital Statistics System to study deaths caused by ruptured aortic aneurysm between 1999 and 2016.

Of 104,458 deaths, the mean age was 77 ± 11 years, 62% were men, and 92% were Caucasian. The overall age-adjusted incidence of fatal ruptures was 23 per 1 million; specifically, abdominal, 15.1 per million; thoracic, 3.1 per million; and thoracoabdominal, 0.4 per million.

The annual incidence of rupture decreased by 68%, from 40 per million in 1999 to 13 per million in 2016. These trends were consistent across age groups, sex, and race. Other notable trends included a seasonal variation, with the highest rupture rates in winter, and a regional variation, with the lowest rates in the southern United States.

The investigators also found that a significant number of rupture deaths occurred in patients not currently included in screening guidelines: 43% of deaths occurred in women (34%) or men < 65 years old (9%).

“Further studies are required to identify the efficacy and cost-effectiveness of population-based screening for an aneurysm in women,” advised Dr. Milner in the SVS press release.

 

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