Let's just measure your aorta, sir

Deaths from ruptured arteries are rising, yet screening is scarce, says Rob Stepney

Peter Brooker is lucky to be alive. A retired businessman in his mid-sixties, he was last year admitted to hospital for surgery on the bowel. While he was on the operating table, surgeons noticed that his aorta, the main artery that carries blood from the heart to the lower body, was abnormally enlarged. Fit, in fact, to burst. As soon as Mr Brooker recovered from one operation he was back in theatre to have his aorta repaired. He made a good recovery.

George Mason was not so fortunate: he died last year of a ruptured aorta. There were no warning signs and Mr Mason, a publican, also in his sixties, was dead within hours of first becoming ill.

About 5,000 people, three-quarters of them men, die each year following a rupture of the aorta. The death toll from this aortic aneurysm is steadily rising. Most of these deaths could be prevented by screening to detect the abnormal ballooning out of the blood vessel that precedes its bursting. The ultrasound examination needed is quick, safe and simple enough to be carried out in GPs' surgeries.

Yet Gloucestershire is the only health authority in the country to have set up a screening programme for aortic aneurysms. During the past five years, 80 per cent of all men aged 65 and over in the county have had the size of their aortas measured. The normal aorta can be as large in cross-section as a 50p piece. People with aortas double that diameter are advised to have a corrective operation, in which a tube of the artificial fibre dacron is inserted within the weakened section of the blood vessel.

Fifty such operations have been carried out among the 10,000 Gloucestershire men who have been screened so far. The 5 per cent of men whose aortas were larger than normal, but not large enough for immediate surgery, are being followed up in the community or as hospital outpatients.

Controversies over screening for other conditions, such as prostate cancer, show that trying to diagnose disease at a stage before it causes symptoms is not always straightforward. A much-enlarged aorta may still not burst, so screening could lead to unnecessary treatment. And even with the best surgeons, correcting an aortic aneurysm is a tricky procedure. Up to five in 100 patients die as a result of the operation, so early detection has potential drawbacks as well as benefits. "Research is needed to determine the cost-effectiveness of screening," says Dr Maclean Baird, medical spokesman for the British Heart Foundation.

However, those who have put screening into practice take a different view. "If an undiagnosed aneurysm bursts, there is only a 10 per cent chance of survival," says Brian Heather, vascular surgeon at Gloucestershire Royal Hospital. "We are seeing a definite reduction in cases of rupture coming in for emergency surgery. Screening will save lives. The question is one of cost and political acceptability. The lives saved are of relatively elderly men. They may be unproductive in economic terms - but many have a lot to live for."