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The NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP)

16 Jul
I was reading my latest edition of GP magazine  or my ‘medical comic’ as my husband says and there was an article on the National  AAA Screening Programme  which began in March 2009, following research that showed it could reduce the rate of premature death from ruptured AAA by 50 per cent. The roll-out across the whole of England should be complete by 2013, as Ealing has not been screened yet those over 65yr old men should be hearing more about this in the coming weeks.

What is an Abdominal Aortic Aneurysm?
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An abdominal aortic aneurysm is a dilation (ballooning) of part of the aorta that is within the abdomen. An abdominal aortic aneurysm (AAA) usually causes no symptoms unless it ruptures (bursts). A ruptured pAAA is often fatal. An AAA less than 55 mm wide has a low chance of rupture. An operation to repair the aneurysm may be advised if it is larger than 55 mm, as above this size the risk of rupture increases significantly.
40 mm-55 mm: about a 1 in 100 chance of rupture per year.
55 mm-60 mm: about a 10 in 100 chance of rupture per year.
60 mm-69 mm: about a 15 in 100 chance of rupture per year.
70 mm-79 mm: about a 35 in 100 chance of rupture per year.
80 mm or more: about a 50 in 100 chance of rupture per year.
As a rule, for any given size, the risk of rupture is increased in smokers, males, those with high blood pressure, and those with a family history of an AAA.
Here we go again prevention again  those same old high risk factors appearing again!

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It has been claimed that no aspect of vascular disease management has changed as much in the past decade as the management of abdominal aortic aneurysm (AAA). Repair of an abdominal aortic aneurysm may be performed surgically through an open incision in the abdomen and inserting a graft or in a minimally-invasive procedure called endovascular aneurysm repair (EVAR) which involves inserting a stent-graft via the major arteries in the legs (femoral artery) Under X-ray guidance involving no abdominal incision. The EVAR  can be carried out under epidural and in patients that would be unable to cope with a general anaesthetic.
It reminded me of those on -call days as a surgical houseman admitting someone with a leaking AAA  involved a long surgical procedure and often a prolonged hair-raising recovery which in those days for me meant little sleep  and watchful waiting…    often going back to theatre as the rather crude grafts leaked or became infected as the surgery was performed by a General  surgeon  rather than the skilled vascular surgeons of today. Many patients were too ill to cope with general anaesthetic and the complication and death rate was high.
Those days are past the prognosis for treatment has drastically improved so it makes sense to screen and offer a good outcome to those who are found to have an AAA before symptoms such  as a pulsing feeling in the abdomen, similar to a heartbeat and/or pain  in the  abdomen or lower back are apparent.
< NHS AAA Screening Programme
A new NHS AAA Screening Programme is being gradually introduced across England and aims to reduce deaths from ruptured Abdominal Aortic Aneurysms through early detection.

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The roll-out of the National Screening Programme  began in March 2009, following research that showed it could reduce the rate of premature death from ruptured AAA by 50 per cent. The roll-out across the whole of England should be complete by 2013.
The NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP) has been rolled out across England and increasing numbers of men will have to  choose whether to undergo screening, which accounts for
approximately 2% of all deaths in this population group.
The NAAASP only screens men aged 65 and over. However,younger men, or women with a family history, can be scanned under existing NHS procedures.
GPs are recommended to consider referring patients with a sibling or parent with an AAA for a scan at the medical imaging department at an age five years younger than that at which their relative’s AAA was first diagnosed.
Self-referral may be appropriate  if a patient missed out on an automatic invitation.
Screening for AAA
An AAA occurs because of degeneration of the wall of the abdominal aorta. Large AAA are rare, but can be very serious;ruptured AAA accounts for about 5,000 deaths every year in England and Wales. Small AAA pose little immediate risk, but can expand, so it is essential to monitor them.
The screening process for AAA is a simple ultrasound scan and patients receive their results immediately. This ensures that men with a small AAA who require regular ultrasound surveillance are identified and offered advice on reducing cardiovascular risk factors. Their GP may be asked to review their medication and reassess their BP monitoring.
Antiplatelet and statin therapy is recommended for men with a small AAA and smoking cessation can reduce the rate of expansion, in addition to its other health benefits.
Other screening outcomes include a small number of men with an aorta of 5.5cm diameter or more, who are referred to a vascular surgery team. Most men who have no signs of an AAA are reassured.
The main risk factors for AAA are smoking, hypertension and a family history (first-degree relative with AAA). Men who are most likely to benefit from self-referral for screening are therefore those in their late 60s and early 70s who have one or more of these factors.
Each GP practice is informed when a patient of theirs is screened, then updated with the results. Patients can then discuss the results with their GP.
For more information:-
Benefits and risks
Despite only just completing national roll-out, the programme has already delivered promising results. NAAASP data for 2012-13 show that 209,000 men were screened for the first time during the year, with 77% of those invited actually attending.
More than 3,000 aneurysms were detected. While most were small and will need regular monitoring, a few patients werenreferred to vascular surgeons to discuss possible treatment options.
More than 300 large aneurysms were detected by screening and treated during the year, and the programme is making progress towards its aim of reducing deaths from ruptured AAA among men aged 65 and over by up to 50%.
In addition to delivering clinical benefits, the NAAASP has been assessed by the UK National Screening Committee as deliveringnvalue for money to the NHS.
There are, however, risks associated with AAA treatment, which are clearly communicated to men when they are invited for screening.
If a large AAA is detected or develops, intervention carries risk – the mortality rate following elective AAA repair is about 2%.

Screening is a patients choice and if unsure it is always advise able to consult your GP regarding individual risks and benefits.

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