Effectiveness of Screening for Abdominal Aortic Aneurysm During Echocardiography

• This is the first multicenter study assessing the prevalence of abdominal aortic aneurysm (AAA) in patients undergoing echocardiography and the feasibility of its screening right after cardiac imaging.
• The imaging quality was satisfactory in 96.7%. The abdominal aorta imaging was performed in <3 minutes in 96.4% of cases.
• Among patients ≥65 years undergoing echocardiography, the prevalence of AAA was found to be 3.7%, with higher rates in men (5.4%) than women (1.4%).
• The screening for AAA at the end of echocardiography is highly feasible and should be advocated, especially in men.

Screening patients with abdominal aortic aneurysm (AAA) is associated with reduced AAA-related mortality, but population screening is poorly implemented. Opportunistic screening during imaging for other indications might be efficient. Single-center series reported AAA rates of 0.8% to 6.5% in patients undergoing transthoracic echocardiography (TTE), with disparities due to selection bias. In this first multicenter study, we aimed to assess the feasibility and criteria for screening AAA during TTE in real-life practice. During a week of May 2011, 79 centers participated in a nationwide survey. All patients aged ≥65 years requiring TTE for any indication were eligible, except for those with operated abdominal aorta. We defined AAA by an anteroposterior diameter of the infrarenal aorta ≥30 mm. Of 1,382 consecutive patients, abdominal aorta imaging was feasible in 96.7%, with a median delay of 1.7 minutes (>3 minutes in 3.6% of cases). We found AAA in 50 patients (3.7%). Unknown AAA (2.7%) was more frequent in men than women (3.7% vs 1.3%, respectively, p = 0.007) and increased by age at 2.2%, 2.5%, and 5.8% in age bands of 65 to 74, 75 to 84, and 85+ years, respectively. None of the female participants aged <75 years had AAA. Smoking status and family history of AAA were significantly more frequent among patients with AAA. The ascending aorta was larger in those with AAA (36.2 ± 4.7 vs 34.0 ± 5.2 mm, p = 0.006), and bicuspid aortic valve and/or major aortic regurgitation were also more frequent (8% vs 2.6%, p = 0.017). In conclusion, rapid AAA screening during TTE is feasible and should be limited to men ≥65 years and women ≥75 years.