Presentation (CTI)

OBJECTIVES: Abdominal aortic aneurysm (AAA) surveillance monitors AAA size and recommends when surgical intervention should be offered. However, no guidance on when patients can safely exit surveillance is available in England, resulting in long-term surveillance, even when intervention may no longer be possible. Through an evidence map and rapid review performed for NHS England, this research aimed to identify, analyse and critique evidence that could support an evidence-based exit strategy from AAA surveillance, and highlight evidence gaps, to facilitate decision-making and direct future research.
METHODS: Searches of MEDLINE, Embase, Google Scholar, health technology assessment websites, national guidance sources and grey literature (2005 to 2025) were conducted. Supplementary search techniques were also employed. Two reviewers performed screening (minimum 20% double-screening) and data extraction. The evidence map output included narrative study summaries, while formal synthesis, risk of bias assessment and Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-style certainty assessments performed for the subsequent rapid review.
RESULTS: Overall, 25 studies were included. Key findings from the quantitative evidence were potential for reduced mortality with adherence vs non-adherence to recommended ultrasound surveillance, potential links between higher growth rates and AAA events, high proportions of those aged ≥80 years unable to receive intervention, and that frailty may already be one consideration in decisions about stopping surveillance. Synthesis of qualitative studies highlighted 10 key findings, including the value of surveillance to patients, clinicians’ ethical concerns about continuing surveillance where intervention is not feasible and the importance of shared decision-making.
CONCLUSIONS: This research highlights the future risk of AAA-related events, poor health, frailty and fitness for intervention, and patient preferences, as important considerations in discussions about stopping surveillance, with discussions in those aged ≥80 years potentially particularly useful (although age alone should not drive decisions). The importance of shared decision-making and setting patient expectations about future intervention is also clear.