Diagnostic aspects of abdominal aortic aneurysm disease in men with reference to population-based screening. : Possibilities for refinement of ultrasound screening for abdominal aortic aneurysm in 65-year-old men.
(2025) In Lund University, Faculty of Medicine Doctoral Dissertation Series- Abstract
- Introduction Abdominal aortic aneurysm (AAA) mainly affects elderly men, grows slowly, and carries high mortality if left untreated, as rupture risk increases with larger diameters. AAA is well suited for screening due to its slow progression, long latent phase, reliable diagnostics, and established treatments. The primary aim of this thesis was to assess whether absolute infrarenal aortic diameter (IAD) or IAD relative to body surface area (BSA) better predicts aneurysm growth toward rupture-prone sizes, using the criterion IAD ≥ 1.5 times the expected diameter. A secondary aim was to evaluate whether screening can be simplified using more affordable, mobile ultrasound devices without compromising diagnostic accuracy.
Methods Data... (More) - Introduction Abdominal aortic aneurysm (AAA) mainly affects elderly men, grows slowly, and carries high mortality if left untreated, as rupture risk increases with larger diameters. AAA is well suited for screening due to its slow progression, long latent phase, reliable diagnostics, and established treatments. The primary aim of this thesis was to assess whether absolute infrarenal aortic diameter (IAD) or IAD relative to body surface area (BSA) better predicts aneurysm growth toward rupture-prone sizes, using the criterion IAD ≥ 1.5 times the expected diameter. A secondary aim was to evaluate whether screening can be simplified using more affordable, mobile ultrasound devices without compromising diagnostic accuracy.
Methods Data from the AAA screening program for men in Malmö, from 2010 to 2017 was used in Study I and II; first to assess the relationship between IAD and BSA and then to assess the relationship between AAA growth and BSA. In Studies III and IV, men with an IAD of 25–29 mm at screening were re-examined; Study III assessed growth in relation to expected IAD (Study I definition), and Study IV compared handheld and stand-ard ultrasound regarding bias, repeatability, and diagnostic accuracy.
Results In Study I, correlation between BSA and IAD in 14,883 men supported using IAD ≥ 1.5 times ex-pected for AAA diagnosis, increasing detection rate by 30 %. In Study II, AAA in 301 men had a mean growth rate of 1.6 mm/year, with no correlation to BSA. In Study III, 270 men with IAD 25–29 from screening were re-examined and those with an IAD ≥ 1.5 times expected grew 0.5 mm/year more compared to controls, but time to reach 40 mm differed by less than half a year. In Study IV, 230 men were examined, with a wider repeatability interval for handheld ultrasound but comparable accuracy to standard ultrasound for detecting AAA.
Conclusion IAD correlates with BSA, allowing for individualisation of AAA diameter criteria, whereas AAA growth does not. Adjusting the diagnostic threshold for AAA based on BSA, rather than a fixed diameter, may improve the identification of aneurysms likely to reach rupture-prone sizes during screening. Handheld ultra-sound devices are feasible for use in AAA screening. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/3111811d-e827-4e9e-a799-ff07aa02cc5b
- author
- Starck, Joachim LU
- supervisor
-
- Jan Holst LU
- Anders Gottsäter LU
- Håkan Pärsson LU
- opponent
-
- Adjunct Professor, Head of Department Hultgren, Rebecka, Karolinska Institutet
- organization
- publishing date
- 2025
- type
- Thesis
- publication status
- published
- subject
- keywords
- Human, Male sex, Screening, Aortic aneurysm, abdominal, Growth rate, Ultrasound
- in
- Lund University, Faculty of Medicine Doctoral Dissertation Series
- issue
- 2025:124
- pages
- 110 pages
- publisher
- Lund University, Faculty of Medicine
- defense location
- Medelhavet, Inga Marie Nilssons gata 53, ingång 46, Skånes Universitetssjukhus i Malmö. Join by Zoom: https://lu-se.zoom.us/j/62969346197?pwd=eHCGZLIgXRCkFMg22LtmoYUU4Ngagk.1
- defense date
- 2025-11-07 09:00:00
- ISSN
- 1652-8220
- ISBN
- 978-91-8021-777-4
- language
- English
- LU publication?
- yes
- id
- 3111811d-e827-4e9e-a799-ff07aa02cc5b
- date added to LUP
- 2025-10-11 17:00:16
- date last changed
- 2025-10-20 08:47:16
@phdthesis{3111811d-e827-4e9e-a799-ff07aa02cc5b,
abstract = {{Introduction Abdominal aortic aneurysm (AAA) mainly affects elderly men, grows slowly, and carries high mortality if left untreated, as rupture risk increases with larger diameters. AAA is well suited for screening due to its slow progression, long latent phase, reliable diagnostics, and established treatments. The primary aim of this thesis was to assess whether absolute infrarenal aortic diameter (IAD) or IAD relative to body surface area (BSA) better predicts aneurysm growth toward rupture-prone sizes, using the criterion IAD ≥ 1.5 times the expected diameter. A secondary aim was to evaluate whether screening can be simplified using more affordable, mobile ultrasound devices without compromising diagnostic accuracy.<br/>Methods Data from the AAA screening program for men in Malmö, from 2010 to 2017 was used in Study I and II; first to assess the relationship between IAD and BSA and then to assess the relationship between AAA growth and BSA. In Studies III and IV, men with an IAD of 25–29 mm at screening were re-examined; Study III assessed growth in relation to expected IAD (Study I definition), and Study IV compared handheld and stand-ard ultrasound regarding bias, repeatability, and diagnostic accuracy.<br/>Results In Study I, correlation between BSA and IAD in 14,883 men supported using IAD ≥ 1.5 times ex-pected for AAA diagnosis, increasing detection rate by 30 %. In Study II, AAA in 301 men had a mean growth rate of 1.6 mm/year, with no correlation to BSA. In Study III, 270 men with IAD 25–29 from screening were re-examined and those with an IAD ≥ 1.5 times expected grew 0.5 mm/year more compared to controls, but time to reach 40 mm differed by less than half a year. In Study IV, 230 men were examined, with a wider repeatability interval for handheld ultrasound but comparable accuracy to standard ultrasound for detecting AAA.<br/>Conclusion IAD correlates with BSA, allowing for individualisation of AAA diameter criteria, whereas AAA growth does not. Adjusting the diagnostic threshold for AAA based on BSA, rather than a fixed diameter, may improve the identification of aneurysms likely to reach rupture-prone sizes during screening. Handheld ultra-sound devices are feasible for use in AAA screening.}},
author = {{Starck, Joachim}},
isbn = {{978-91-8021-777-4}},
issn = {{1652-8220}},
keywords = {{Human; Male sex; Screening; Aortic aneurysm, abdominal; Growth rate; Ultrasound}},
language = {{eng}},
number = {{2025:124}},
publisher = {{Lund University, Faculty of Medicine}},
school = {{Lund University}},
series = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
title = {{Diagnostic aspects of abdominal aortic aneurysm disease in men with reference to population-based screening. : Possibilities for refinement of ultrasound screening for abdominal aortic aneurysm in 65-year-old men.}},
url = {{https://lup.lub.lu.se/search/files/229471776/Joachim_Starck_-_HELA.pdf}},
year = {{2025}},
}