Why aneurysm screening is good news

The aneurysm can be repaired - if detected early

Men in England are to be offered screening for a potentially fatal blood vessel condition.

Vascular surgeon Mr Matthew Waltham, explains why a national abdominal aortic aneurysm screening programme is good news and how it would work.

"The Prime Minister's announcement on health screening received a mixed reception.

Screening almost halves the number of aneurysm-related deaths

"Detractors argue that the plans have not been fully evaluated, far less approved by the National Screening Programme, and that the practicalities of implementing a programme have not been thought through.

"They may be right on many counts, however, there is one element of screening which has been widely researched and proven to be worthwhile - screening for Abdominal Aortic Aneurysms (AAA).

No warning signs

Firstly, the facts about AAA: 7% of UK men over 65 have an aortic abdominal aneurysm and, for men, it is the 12th most common cause of death.

Even then, the true figures are somewhat hidden since most home deaths of men over 65 are attributed to heart attacks when many could be from AAA ruptures.

At present, screening is not generally offered to patients, even those at high risk.

Elective surgery to repair an aneurysm carries good odds

If an aneurysm is picked up, usually if a patient is treated or screened for other conditions, then depending on its size, the patient will either be operated on immediately or monitored.

Elective surgery to repair an aneurysm carries good odds - chances of survival are around 95%.

Many aneurysms are undetected until they rupture. In this instance the overall chances of survival are slim: between 6% - 22% survive, with 50% dying before they even make it to hospital.

Screening almost halves the number of aneurysm-related deaths.

Economically sound

This was confirmed by evidence from a large randomised trial involving over 67,000 men - the Multicentre Aneurysm Screening Study (MASS), which also proved it was economically sound.

Following the study's publication, the National Screening Committee examined the evidence and approved a nationwide screening programme and the Vascular Society began campaigning for its implementation.

The government's commitment to screening for aneurysms is the culmination of that work.

In terms of implementation, the Vascular Society has already thought through the practicalities.

It will be essential that the government provides funding for the training of sonographers and for the correct infrastructure to ensure a high quality service.

Screening programme

I have been setting up a screening programme across Southwark and Lambeth, funded by Guys and St. Thomas's charity, and there are similar pilot programmes across the UK.

In my programme, screening is organised by Guy's and St. Thomas' Hospital and done at GP practices.

All GPs have to do is agree for patients to partake in the programme and make a room available where the simple ultrasound can take place.

Most patients will be clear, the small percentage deemed to be at risk will be referred to vascular teams at the relevant hospital and either monitored or operated on immediately.

At present, many AAAs are repaired with open surgery, which is high risk and often involves intensive care and prolonged recovery periods, so is very costly.

More recently, a less invasive and safer method of repair called EVAR (endovascular aneurysm repair) is being adopted, which involves mending the AAA via two small cuts to the groin, under regional anaesthetic.

The introduction of national screening programme is a breakthrough for AAA campaigners like myself.

However, second target should be the provision of the highest standards of vascular surgery including the choice of EVAR as a treatment, as it offers even better survival rates than open surgery.