Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms

Background: Long‐term benefits of screening for abdominal aortic aneurysm (AAA) are uncertain. These are the final results of a randomized controlled screening trial for AAA in men, updating those reported previously. Benefit and compliance over a median 15‐year interval were examined. Methods: One group of men were invited for ultrasonographic AAA screening, and another group, who received standard care, acted as controls. A total of 6040 men aged 65–80 years were randomized to one of the two groups. Outcome was monitored in terms of AAA‐related events (surgery or death). Results: In the group invited for screening, AAA‐related mortality was reduced by 11 per cent (from 1·8 to 1·6 per cent, hazard ratio 0·89) over the follow‐up interval. Screening detected an AAA in 170 patients; 17 of these died from an AAA‐related cause, seven of which might have been preventable. The incidence of AAA rupture after an initially normal scan increased after 10 years of follow‐up, but was still low overall (0·56 per 1000 person‐years). Conclusion: Screening with a single ultrasonography scan still conferred a benefit at 15 years, although the results were not significant for this population size. Fewer than half of the AAA‐related deaths in those screened positive could be prevented. Registration number: ISRCTN 00079388 (http://www.controlled‐trials.com). Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Small late benefit