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Abdominal Aortic Aneurysm (AAA) Screening



The NHS Abdominal Aortic Aneurysm (AAA) screening programme has been introduced across England and the Implementation began in March 2009. University Hospitals of Leicester (UHL) was one of the first six pioneer Institutions in the country to implement screening for abdominal aortic aneurysm. Prior to becoming a part of the national programme between 1996 and 2009 the UHL offered a voluntary ‘opt’ in screening programme for the GP practices which achieved approximately 40% coverage of the Leicester, Leicestershire and Rutland area. 

With the implementation of the National Screening Programme in 2009, this has now been extended to cover all GP surgeries across Leicester, Leicestershire and Rutland. The screening test is very quick, painless and reliable. 

 Leicester, Leicestershire and Rutland AAA screening programme activity in 2018/2019. 

 We invited 5844 men for screening in total, among them 4707 attended their screening appointment. This is an uptake of 80.40%. In addition we also screened 84 older men who had self-referred to the service. We detected 43 AAA's in this cohort and made 39 referrals for consideration of surgery. 

Abdominal Aortic Aneurysm (AAA) Aorta illustration
What is an Abdominal Aortic Aneurysm? 

Abdominal aortic aneurysm is a balloon - like swelling of the aorta, the main artery leading away from your heart which passes through your abdomen. It can be serious if it is not spotted early on because it could get bigger and eventually burst (rupture). 

 Prevalence: 

a. Around 1 in 92 men aged 65 in England has an AAA. .   

b. Around 3,000 deaths each year in men aged 65 and over in England and Wales from ruptured AAA .      

c. Deaths from ruptured AAA account for 1.7% of all deaths in men aged 65 and over. 

What are the Symptoms of having an AAA? 

 Abdominal aortic aneurysms often grow slowly without symptoms, making them difficult to detect. This is why the AAA screening programme  was introduced, following research, which showed it could reduce the rate of premature death from ruptured AAA by 50% by detecting and treating large aneurysms before they burst. Around 1 in 92 men who are screened have an AAA. 

 Diagnosis:

 A simple ultrasound scan is performed to detect an AAA. 

 985 in 1000 men who are screened have normal results 

 14 in 1000 men are found with smaller to medium aneurysm 

 1 in 1000 men had large aneurysm( Aortic diameter 5.5cm or above) 

Early detection When an aneurysm is detected early, treatment is safe and effective and the aneurysm is curable.   

Who is at risk?

People at a higher risk of getting an AAA include: 

 a.    Men are six times more likely to develop an aneurysm than a woman. The chance of having an aneurysm increases with age. Two out of every three deaths from ruptured AAA in England and Wales occur in men who are over 65. 

b.    people who smoke – if you smoke or used to smoke, you're up to 15 times more likely to get an AAA 

c.    people with high blood pressure – high blood pressure can double your risk of getting an AAA 

d.    people with a parent, sibling or child with an AAA – you're about four times more likely to get an AAA if a close relative has had one  

Results of AAA screening:

Immediately after the scan, men will be informed of the result of the test by the screening practitioner.

Negative result

Men will not be asked to return to have another scan and will be discharged from the screening programme.

Positive result

If an AAA is detected ,  the patient pathway and the implications of the diagnosis are fully explained to men in a clear, concise and sensitive way. General Practitioners will be informed of the outcome of all positive AAA scans.

 What happens next?

Small AAA:

• Men found to have an AAA less than 4.5 cm in diameter will be asked to attend for yearly follow-up scans to monitor any increase in size.Just over 1% of men screened have a small AAA. 

Read a leaflet on small AAA (PDF, 2.3Mb) for more information.

Medium AAA:

• Men found to have an AAA between 4.5 cm and 5.4 cm will be asked to attend for follow up scans every three months.About 0.5% of men screened have a medium AAA. 

Read a leaflet on medium AAA (PDF, 2.3Mb) for more information.

Large AAA:

• Men found to have an AAA greater than 5.4 cm will be referred by the programme to a local vascular service for assessment. About 0.1% of men screened have a large AAA.As large AAAs  are at the highest risk of bursting if left untreated, you'll be referred to a specialist surgeon within 2 weeks to talk about your treatment options.

Most men with a large AAA are advised to have surgery to stop it getting bigger or bursting. 

Read a leaflet on large AAA (PDF, 2.2Mb) for more information and read about how a large AAA is treated.


Steps patients can take which may slow down the growth of an AAA? 

a.  stopping  smoking – read stop smoking advice and find out about Smokefree,, the NHS stop smoking service

b.  eating healthily – eat a balanced diet  and  cut down on fatty food

c.  exercising regularly – at least 150 minutes of exercise a week; read about how to get started with some common activities

d.  maintaining a healthy weight – use the healthy weight calculator to see if you might need to lose weight, and  find  out how to lose weight safely

e.  cutting down on alcohol – read some tips on cutting down and general  advice about alcohol

f.   make sure your blood pressure is normal, if you have not had it checked it recently, it is worth getting it checked. 

g. If you have a high blood pressure , your GP may also recommend taking tablets to treat this. 

 Ruptured AAA Symptoms:

 If your aortic aneurysm ruptures, you will feel a sudden and severe abdominal pain and/or Lower back pain

It is a medical emergency and seek help through accident and emergency by calling 999

 Other symptoms include: dizziness sweaty and clammy skin rapid heartbeat (tachycardia) shortness of breath feeling faint  Loss of consciousness.   Around 85 out of 100 people with a rupture AAA die before they reach hospital or don’t survive emergency surgery. 

To help you decide if you should be screened you can visit the AAA screening patient Decision Aid at                    Abdominal aortic aneurysm screening: short form decision aid

Self-Referral: 

(Leicester, Leicestershire & Rutland) Men who are older than 65 years, and never been screened or treated for an abdominal aortic aneurysm, can self-refer by contacting the screening office on 0116 258 6820 

This leaflet provides information about abdominal aortic aneurysm screening (also called AAA screening) for men who have been invited for screening by the National Screening Programme.

 Can access AAA leaflets in many languages from below given link: https://www.gov.uk/government/publications/abdominal-aortic-aneurysm-screening-invitation-leaflet 

An easy read guide is available.



Frequently asked Questions   

The United Kingdom Aneurysm Growth Study 
The unit regularly participates in the identification of patients to be invited into research projects. Attending for screening will not automatically mean that you are involved in research; rather, you may be offered the opportunity to take part if you wish to. You do not have to take part in research if you do not want to and this will not affect the care you receive from the screening unit.   As an example, we have recently been inviting men screened for AAA if they would like to take part in a national research project, The United Kingdom Aneurysm Growth Study, which is being run from the University of Leicester. In this project both men found to have aneurysm, and men who do not have aneurysm, are being invited to provide some basic information about their medical background and blood samples (all on a strictly confidential basis) so that the research team can investigate what causes aneurysm and what makes the increase in size. 

More links 

https://www.nhs.uk/search?collection=nhs-meta&query=aneurysm 

http://www.circulationfoundation.org.uk/help-advice/abdominal-aortic-aneurysm 

https://www.gov.uk/government/news/thousands-of-lives-to-be-saved-in-biggest-roll-out-of-abdominal-aortic-aneurysm-screening

https://www.nhs.uk/conditions/abdominal-aortic-aneurysm/ 

www.nhs.uk/Livewell/Healthyhearts/Pages/Cholesterol.aspxCached www.nhs.uk/conditions/blood-pressure-(high)/pages/introduction.aspxCached 

http://news.bbc.co.uk/1/hi/england/leicestershire/8242966.stm 

https://www.leicestershospitals.nhs.uk/aboutus/our-news/press-release-centre

https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidancentryid8=26668