NAAASPで監視されている中小腹動脈動脈瘤の男性の安全性

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.).

Circulation

|January 15, 2019

まとめ

腹動脈動脈瘤 (AAA) の監視下にある男性は,破裂のリスクが低い. 集中的なモニタリングは,小から中程度のAAAを持つ人の安全性を保証し,現在の5. 5cmの参照値を変更する必要はありません.

科学分野:

血管外科
公衆衛生スクリーニング
エピデミオロジー

背景:

腹動脈動脈瘤 (AAA) の集団スクリーニングは死亡率を最大50%減少させます.
検査結果が陽性だった男性のAAAは治療基準の5. 5cm未満で,監視の対象となった.
この研究は,AAAの監視を受けている男性における破裂リスクを評価しています.

研究の目的:

超音波の監視下にある男性において,破裂したAAA (rAAA) のリスクを決定する.
検出されたAAAに対する現在の監視プロトコルの安全性を評価する.
AAA治療のための5. 5cmの基準値の適切性を評価する.

主な方法:

国立保健局のAAAスクリーニングプログラムで小 (3~4. 4cm) または中等 (4. 5~5. 4cm) のAAAを持つ男性の追跡調査.
AAA直径のデータ収集,参照日,スクリーニングデータベースからのフォローアップの損失
初期および最終AAA直径に基づく破裂および死亡率の計算

主要な成果:

18,652人の男性を50,103人年間追跡し,31人がrAAA (29人が死亡) を経験した.
総死亡率は年間1. 96%で,心臓血管疾患と癌が主な原因でした.
年間rAAAリスクは,小AAAでは0. 03%,中AAAでは0. 28%,5. 5cmの値に近い場合は0. 40%に上昇した.

結論:

監視期間中のrAAAの年間リスクは,5. 5cmのリファレンスの値を下回るAAAでも0. 5%未満です.
小型および中型スクリーンで検出されたAAAを持つ男性は,集中的な監視下で安全です.
現在の証拠は,AAA治療のための5. 5cmのリファレンス値の変更を支持しません.

キーワード:

大動脈動脈瘤,腹部流行病学についてマススクリーニング男たち超音波検査

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