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Should I scan relatives for aortic aneurysm?

Q Is screening recommended for relatives of patients with aortic aneurysm? If so, should it be a single scan or should it be repeated at regular intervals?

A There is an important genetic component to abdominal aortic aneurysm (AAA). Whereas about 5 per cent of men over 65 will have an AAA, this figure increases to 20 per cent if a first-degree relative has one. AAA is much less common and presents at a later age in women.

The overall mortality from a ruptured AAA is about 85 per cent, whereas that from elective repair is 5-10 per cent (although of course not all aneurysms will rupture if left untreated).

The UK small aneurysm trial has shown it is normally safe to observe asymptomatic AAA of less than 5.5cm. The large majority of screen-detected aneurysms will be small; these will need observation rather than surgery.

Even with a positive family history, AAA is rare before middle or old age.

However, once a relative is concerned about the possibility of an AAA it is reasonable to scan with ultrasound and then repeat about once every five years if normal (even longer intervals for a young patient).

In contrast, for mass screening a single scan at around 65 seems sufficient with no further scan if less than 2.5cm.

Drug treatments to reduce expansion rates are likely to become available.

Ultrasound is a safe, effective and inexpensive screening technique.

Shane MacSweeney is consultant in vascular surgery at the Queens Medical Centre, Nottingham

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