**Part 1**

**Evolution of Care for Aortic Disease** 

**1** 

**The Evidence for Management of** 

Reza Mofidi1 and Stuart A. Suttie2

*2University of Dundee, Dundee,* 

*United Kingdom* 

*1James Cook University Hospital, Middlesbrough* 

**Abdominal Aortic Aneurysms: Lessons** 

**Learned from Randomised Controlled Trials** 

Abdominal aortic aneurysm (AAA) is a common life threatening condition in the western world. In England and Wales alone, over 2500 patients present to hospital with rupture of AAA annually, of whom over two thirds die of their condition1. The best treatment for AAA is elective repair of pre-symptomatic abdominal aortic aneurysms. Such a therapeutic strategy depends on effective identification of patients with AAA and the subgroup of patients in whom there is a real risk of aneurysm rupture. As the vast majority of patients with AAAs are asymptomatic, timely identification of AAA may be achieved through targeted screening of the at risk populations. Over the last two decades longitudinal studies of patients with smaller AAAs have provided insights into the timing of AAA repair and the need for and frequency of ultrasound surveillance if an expectant management strategy is followed. This chapter discusses the available evidence for screening for AAA as well as all the other measures which have helped to optimise therapeutic strategies in the management of patients with AAA throughout the patients' journey from the initial diagnosis to the

In the past 40 years with the advent and generalised use of abdominal ultrasonography there has been an accurate, cheap and non invasive tool for the diagnosis of abdominal aortic aneurysms. Abdominal ultrasonography has been found to be an accurate and reproducible modality in measuring the dimensions of AAA. This has led to the concept of its use for screening of at risk populations. In the last 20 years there have been four population based randomised controlled trials which have assessed the value of targeted screening in reducing mortality from abdominal aortic aneurysms in the unselected elderly male population2-5. These trials which have been undertaken in Chichester (England)2, England (MASS trial) 3, Viborg County (Denmark) 4 and the city of Perth and suburbs (Western Australia)5 have together recruited over 120,000 subjects. All of these studies have reported on long term (over 10 years) follow up. Using the predefined criteria set by the US Preventative Screening Task Force USPSTF 6 the MASS trial has been classified as good with

**1. Introduction** 

eventual repair of AAA.

**2. Targeted screening for AAA** 
