Ruptured abdominal aortic aneurysms: decreasing incidence may reduce the impact of a Scottish screening programme

Objectives: The aim of this study was to determine whether there has been a change in annual ruptured abdominal aortic aneurysm admissions and elective abdominal aortic aneurysm repairs in a tertiary vascular surgery department. Methods: All patients admitted with ruptured abdominal aortic aneurysm from 1987 to 2009 and all undergoing elective abdominal aortic aneurysm repair from 1995 to 2009 were identified from the local surgical audit database. Annual ruptured abdominal aortic aneurysm admissions were calculated and compared in the first and second halves of the study period. Results: During a 23-year period, 888 patients (male 728, female 158, gender was not documented for two patients) were identified with a ruptured abdominal aortic aneurysm. The annual number of admissions remained relatively constant from 1987 to 1997, with a mean of 44 (95% CI 39.91-48.09). There was a significant decrease to a mean of 33.67 per annum (95% CI 28.53-38.8) in the period 1998-2009, p = 0.006. The mean mortality was 39.8% and showed no significant decrease. There was no increase in the number of elective abdominal aortic aneurysm repairs during the study period. Conclusions: This study suggests that the incidence of ruptured abdominal aortic aneurysms is decreasing, mirroring the trend seen in other cardiovascular disease. As such, further analysis as to the cost-effectiveness of a Scottish screening programme is merited.