Screening and Vascular Health Checks

Screening for vascular disease

Abdominal Aortic Aneurysms

An abdominal aortic aneurysm (AAA) is a swelling of the main artery running in the abdomen. AAA occur more frequently in men than women and in an older age group, generally over 65. In the UK there is a NHS national screening programme. When men turn age 65 they are invited for a ultrasound scan to look for an AAA. The NHS website contains details of the programmehttps://www.nhs.uk/conditions/abdominal-aortic-aneurysm-screening/

The ultrasound test is a very straight forward examination and takes about 10-15 minutes to perform. The scan is very similar to a baby scan, involving some ultrasound gel placed on the tummy and then an ultrasound scanner is placed on the tummy mainly above the belly button (umbilicus) to look for an AAA. If it is found a measurement can usually be taken there and then and you advised immediately about the result.

The screening programme started in 2009 and invited men only as they turned 65. So as of 2023 men aged 80 and above will never have been invited for a screening test. Both men and women are able to self refer to the screening programme in order to have the test.

Carotid Artery Disease

The carotid artery supplies the brain with blood flow. The carotid artery travels from the chest, up through the neck from the heart and into the skull to supply the brain. In some patients the carotid artery can become furred up causing a narrowing (stenosis) in the blood vessel. This narrowing can be a rough surface and so small blood clots can form inside the vessel which then dislodge and travel up to the brain. If this happens it can cause a full stroke or mini-stroke (TIA).

A carotid endarterectomy is an operation that clears out the artery to leave a smoother surface again, thereby reducing the risk of a further stroke. The operation involves opening the carotid artery and halting the blood flow through it for a short period of time. The major risk of the operation is to cause a stroke. This occurs in about 2-3% of patients. The operation is therefore only carried out if there is a significant narrowing of the carotid artery. A narrowing of 50% of more is considered significant. In addition the large scale trials have shown benefit in patients who have had a stroke in the last six months and have a significant narrowing.
The alternative intervention to surgery is carotid stenting. Most of the major research trials have shown stenting to be inferior to surgery in terms of the procedural stoke risk. The main place for carotid artery stenting is when surgery is technically challenging such as if the patient has had previous neck surgery or radiotherapy, or if the narrowing in the artery is not accessible as it is too close to the skull.

The role of carotid endarterectomy in patients that have not had a stroke (i.e. asymptomatic carotid artery stenosis) remains a subject of debate.

At the current time there is no NHS national screening programme for carotid artery disease in the UK population.

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