scholarly journals Modelling the impact of changes to abdominal aortic aneurysm screening and treatment services in England during the COVID-19 pandemic

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253327
Author(s):  
Lois G. Kim ◽  
Michael J. Sweeting ◽  
Morag Armer ◽  
Jo Jacomelli ◽  
Akhtar Nasim ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Screening Programme ◽  
Elective Surgery ◽  
Discrete Event ◽  
Drop Out ◽  
Abdominal Aortic ◽  
Related Service ◽  
The Impact ◽  
Related Mortality

Background The National Health Service (NHS) abdominal aortic aneurysm (AAA) screening programme (NAAASP) in England screens 65-year-old men. The programme monitors those with an aneurysm, and early intervention for large aneurysms reduces ruptures and AAA-related mortality. AAA screening services have been disrupted following COVID-19 but it is not known how this may impact AAA-related mortality, or where efforts should be focussed as services resume. Methods We repurposed a previously validated discrete event simulation model to investigate the impact of COVID-19-related service disruption on key outcomes. This model was used to explore the impact of delayed invitation and reduced attendance in men invited to screening. Additionally, we investigated the impact of temporarily suspending scans, increasing the threshold for elective surgery to 7cm and increasing drop-out in the AAA cohort under surveillance, using data from NAAASP to inform the population. Findings Delaying invitation to primary screening up to two years had little impact on key outcomes whereas a 10% reduction in attendance could lead to a 2% lifetime increase in AAA-related deaths. In surveillance patients, a 1-year suspension of surveillance or increase in the elective threshold resulted in a 0.4% increase in excess AAA-related deaths (8% in those 5–5.4cm at the start). Longer suspensions or a doubling of drop-out from surveillance would have a pronounced impact on outcomes. Interpretation Efforts should be directed towards encouraging men to attend AAA screening service appointments post-COVID-19. Those with AAAs on surveillance should be prioritised as the screening programme resumes, as changes to these services beyond one year are likely to have a larger impact on surgical burden and AAA-related mortality.

Abdominal aortic aneurysm disease: health risks, management and screening

Clinical Risk ◽  
2008 ◽  
Vol 14 (6) ◽  
pp. 208-210
Author(s):  
Hany Hafez
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Health Risks ◽  
Screening Programme ◽  
Non Invasive ◽  
Invasive Test ◽  
Department Of Health ◽  
Abdominal Aortic ◽  
Reduction Of Mortality ◽  
The Impact

Abdominal aortic aneurysm (AAA) disease is a condition that affects mainly men over the age of 65 years. The majority of AAAs will remain asymptomatic and therefore undetected. These undetected aneurysms will invariably grow enough for their walls to rupture leading to death in nearly 75% of those affected. Ultrasound-based AAA screening has been shown to reduce the risk of dying of an AAA by half. This significant reduction of mortality offered by a simple and sensitive non-invasive test has prompted the Department of Health to introduce a national AAA screening programme for England and Wales. In this article, the public health risks of AAA disease together with details of the impact of the anticipated national AAA screening programme are discussed.

Stereoscopically Observed Deformations of a Compliant Abdominal Aortic Aneurysm Model

2011 ◽  
Vol 133 (11) ◽  
Author(s):  
Clark A. Meyer ◽  
Eric Bertrand ◽  
Olivier Boiron ◽  
Valérie Deplano
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Computational Models ◽  
Imaging System ◽  
Strain Differences ◽  
Cyclic Strain ◽  
Experimental Models ◽  
Body Motion ◽  
Abdominal Aortic ◽  
The Impact

A new experimental setup has been implemented to precisely measure the deformations of an entire model abdominal aortic aneurysm (AAA). This setup addresses a gap between the computational and experimental models of AAA that have aimed at improving the limited understanding of aneurysm development and rupture. The experimental validation of the deformations from computational approaches has been limited by a lack of consideration of the large and varied deformations that AAAs undergo in response to physiologic flow and pressure. To address the issue of experimentally validating these calculated deformations, a stereoscopic imaging system utilizing two cameras was constructed to measure model aneurysm displacement in response to pressurization. The three model shapes, consisting of a healthy aorta, an AAA with bifurcation, and an AAA without bifurcation, were also evaluated with computational solid mechanical modeling using finite elements to assess the impact of differences between material properties and for comparison against the experimental inflations. The device demonstrated adequate accuracy (surface points were located to within 0.07 mm) for capturing local variation while allowing the full length of the aneurysm sac to be observed at once. The experimental model AAA demonstrated realistic aneurysm behavior by having cyclic strains consistent with reported clinical observations between pressures 80 and 120 mm Hg. These strains are 1–2%, and the local spatial variations in experimental strain were less than predicted by the computational models. The three different models demonstrated that the asymmetric bifurcation creates displacement differences but not cyclic strain differences within the aneurysm sac. The technique and device captured regional variations of strain that are unobservable with diameter measures alone. It also allowed the calculation of local strain and removed rigid body motion effects on the strain calculation. The results of the computations show that an asymmetric aortic bifurcation created displacement differences but not cyclic strain differences within the aneurysm sac.

scholarly journals Outcomes in Men From the NHS Abdominal Aortic Aneurysm Screening Programme With a Large Aneurysm Referred for Intervention

2021 ◽  
Vol 73 (3) ◽  
pp. 1108
Author(s):  
L. Meecham ◽  
J. Jacomelli ◽  
M. Davis ◽  
A. Pherwani ◽  
T. Lees ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Screening Programme ◽  
Abdominal Aortic ◽  
Large Aneurysm
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