“Focused efforts” required to make AAA screening accessible to all

Maarit Venermo (University of Helsinki and Helsinki University Hospital, Helsinki, Finland) speaks to Vascular News about population screening for abdominal aortic aneurysm (AAA), sharing key findings from the Nordic AAA study and addressing some of the main challenges associated with implementing a successful national screening programme.

How did the idea for the Nordic AAA study originate?

For some time now, we have been studying how the incidence of ruptured AAA has changed over the last 10–20 years in Finland, particularly in the Helsinki region, and have been following the excellent Swedish publications on aneurysm screening. In addition, we noticed in our own studies that despite not having screening in Finland, the incidence of ruptured AAA has decreased somewhat. Therefore, we thought that it would be interesting to evaluate how screening has changed the ruptured AAA incidence and also elective AAA repair rates in Sweden, and compare Finland and Sweden. The Nordic countries have similarities in both healthcare and population structure, as well as in geographical distribution of the population, and hence a comparison of AAA epidemiology between these countries offers insights into how organisation of care can affect AAA outcomes.

You shared some key data from the study at CX Aortic Vienna 2022. Could you outline the headline findings?

The main finding I reported was that the incidence of ruptured AAA has decreased in both Finland and Sweden, with the decrease more pronounced in Sweden—the only country out of the four included in the study (Denmark, Finland, Norway and Sweden) with a national screening programme. I also shared that screening has increased elective repair among 65–80-year-old men, and that, among men over the age of 80 years, there has been a significant increase in intact aneurysm repair.

How does the Swedish national screening programme operate, and how has it impacted detection rates?

The Swedish national screening programme was initiated in 2006, and reached national coverage in 2015. It invites men at age 65 to a single ultrasound screening for AAA. The screening programme has been highly successful, reaching >80% coverage in most areas, and with a prevalence of screening-detected AAA of 1.5%. Previous analysis of Swedish data suggests that the screening programme has significantly reduced AAAspecific mortality in Sweden, and health economic evaluation of the programme shows that this was done in a highly costeffective manner. The main challenge for the screening programme going forward is the fact that the prevalence of AAA in the general 65-year-old male population is decreasing, and it is possible that a modification of the programme will be required with a continuous reduction in prevalence of disease. Another challenge that is an area for research is how to manage individuals with detection of subaneurysmal aorta (i.e. aortic diameter of 25–29mm). A large proportion of these individuals are at risk of developing clinically significant AAA over time, but currently there are no clear guidelines on how follow-up should be organised for this cohort.

What are the main costs, and other challenges, associated