United Kingdom’s NHS AAA Screening Program Explores Outcomes of Men With Large AAA Referred for Intervention

March 9, 2021—A study from the United Kingdom’s National Health Service (NHS) Abdominal Aortic Aneurysm Screening Program (NAAASP) was conducted to explore outcomes in men treated with large aneurysms and to see whether there was any regional variation in treatment rates and type of repair. The study included men with aneurysms referred for intervention. Lewis Meecham, et al, published the findings in European Journal of Vascular & Endovascular Surgery (EJVES; 2021;61:192-199).

As summarized in EJVES, the study cohort included all men referred for intervention to a vascular network with a large (> 54 mm) abdominal aortic aneurysm (AAA) either at first screening or during surveillance. Basic demographic information, nurse assessment details, as well as outcome data were extracted from the NAAASP information technology system, AAA SMaRT, for analysis.

The investigator reported that approximately 3,026 men were referred for possible intervention (48% first screen, 52% surveillance). Approximately 448 (13.3%) men either declined (63, 2.1%), or were turned down for early intervention for various reasons (385, 12.7%; 8% were declined for medical reasons [true turn down rate]). Turn down rates did not vary among local programs when surveillance men were taken into account.

Men referred from surveillance were older and more likely not to have had elective surgery within 3 months (16% vs 11.2%; hazard ratio, 1.37; 95% CI, 1.07-1.75; P = .011) and approximately 2,624 (87%) men had planned AAA repair, with a perioperative mortality of 1.3%. Additionally, the 30-day surgical mortality was lower after endovascular repair compared with open repair (0.4% vs 2.1%).

The investigators observed that the method of repair remained consistent year on year, with roughly equal numbers undergoing endovascular (50%) and open surgical repair (48%); 2% were unknown. There was regional variation in the proportion treated by endovascular repair from 20% to 97%.

The turn down rate after referral for treatment with a screen-detected AAA was low, but there remains considerable regional variation in the proportion undergoing endovascular repair. Additionally, procedures were undertaken with low perioperative mortality, reported the investigators in EJVES.