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Screening for Abdominal Aortic Aneurysms Saves Men's Lives

Regular ultrasound screening for abdominal aortic aneurysms can sharply reduce the likelihood of dying from a ruptured aneurysm among men age 65// and older, according to a new review of recent studies.

Screening helped cut the odds of death nearly in half for men ages 65 to 79 but did not reduce deaths among women.

However, men who received screening were also twice as likely to undergo surgery for the condition, a procedure that carries its own risk of death, says Dr. Paul Cosford of the East of England Strategic Health Authority.

The four studies included 127,891 men and 9,342 women.

The review by Cosford and Dr. Gillian Leng of the National Institute for Clinical Excellence in England appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Aneurysms are places in the aorta that have become wider as the large blood vessel travels through the abdomen. As the artery balloons out at a certain spot, the aorta walls become weaker, increasing the chance that it will burst. A burst aorta is often fatal —almost 80 percent of people who reach a hospital after the aorta ruptures will die.

Screening could help save many of these lives, since surgeons can repair an aneurysm before it bursts, usually before it grows larger than two inches in diameter.

However, screening for these aneurysms is somewhat controversial, since "the balance between risk of rupture and risk of elective surgical repair … is difficult to judge for people who are healthy," Cosford said.

"Patients may therefore be asked to undergo this risk to repair a large aneurysm which may not kill them," he said, adding that some people may also become "signifi cantly anxious" about smaller aneurysms that do not need surgery.

In 2007, after several high-profile news accounts about the condition, Medicare began offering abdominal aortic aneurysm screening for those at high risk for the condition, including men over 65 who have smoked and women with a family history of aneurysms. If the initial screening turns up an aneurysm, the reviewers say that current practice is to do a repeat ultrasound every three to six months for aneurysms smaller than 5 centimeters (2 inches).

Although evidence suggests that the risk of abdominal aortic aneurysm is higher in men than women, Cosford says researchers need to find out more about the benefits and harms of screening in women.

Dr. Angela Vouyouka, a vascular surgeon at New York Presbyterian Hospital, said aneurysms may be a larger problem in women than most researchers think. Women’s aneurysms — and aortas — are smaller than in men, making it more difficult to tell when they have reached a dangerous size, she said.

Older women may also miss out on important screenings for social reasons, she suggested. "At this point of their life women are very likely to either take care of an older and sicker spouse or live alone … they are not seeking medical help or keeping their medical appointments as vigorously as their male counterparts do."

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