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Seguridad de los hombres con aneurismas aórticos abdominales pequeños y medianos bajo vigilancia en el NAAASP

Clare Oliver-Williams^1,2, Michael J Sweeting^1,3, Jo Jacomelli⁴

¹Cardiovascular Epidemiology Unit, Department of Public Health & Primary Care, University of Cambridge, UK (C.O.-W., M.S.).

|January 15, 2019

Resumen

Los hombres en vigilancia por aneurisma aórtico abdominal (AAA) tienen un bajo riesgo de ruptura. El monitoreo intensivo garantiza la seguridad para aquellos con AAA pequeños a medianos, sin necesidad de cambiar el umbral de referencia actual de 5,5 cm.

Área de la Ciencia:

Cirugía vascular
Evaluación de la salud pública
Epidemiología

Sus antecedentes:

El cribado de la población para el aneurisma aórtico abdominal (AAA) reduce la mortalidad hasta en un 50%.
La mayoría de los hombres con resultados positivos en los exámenes de detección tienen AAA menores que el umbral de tratamiento de 5,5 cm y entran en vigilancia.
Este estudio evalúa el riesgo de ruptura en hombres sometidos a vigilancia AAA.

Objetivo del estudio:

Para determinar el riesgo de ruptura de AAA (rAAA) en hombres bajo vigilancia de ultrasonido.
Evaluar la seguridad de los protocolos de vigilancia actuales para los AAA detectados mediante cribado.
Para evaluar la idoneidad del umbral de referencia de 5,5 cm para el tratamiento AAA.

Principales métodos:

Seguimiento de hombres en el Programa de Cribado AAA del Servicio Nacional de Salud con AAA pequeños (3-4,4 cm) o medianos (4,5-5,4 cm).
Recopilación de datos sobre el diámetro de AAA, fechas de referencia y pérdida de seguimiento de las bases de datos de cribado.
Cálculo de las tasas de ruptura y mortalidad basado en el diámetro inicial y final de la AAA.

Principales resultados:

18.652 hombres fueron seguidos durante 50.103 años-persona; 31 experimentaron rAAA (29 fatales).
La mortalidad general fue del 1,96% anual, con las enfermedades cardiovasculares y el cáncer como causas principales.
El riesgo anual de rAAA fue del 0,03% para las AAA pequeñas y del 0,28% para las AAA medianas, aumentando al 0,40% para las cercanas al umbral de 5,5 cm.

Conclusiones:

El riesgo anual de AAA durante la vigilancia es inferior al 0,5%, incluso para AAA justo por debajo del umbral de referencia de 5,5 cm.
Los hombres con pequeñas y medianas AAA detectadas en la pantalla están a salvo bajo vigilancia intensiva.
La evidencia actual no apoya el cambio del umbral de referencia de 5,5 cm para el tratamiento con AAA.

Palabras clave:

Aneurisma de la aorta, abdominal Ciencias de la salud Proyección masiva los hombres ecografía

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