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ABSTRACT

Abdominal aortic aneurysm (AAA) affects approximately 3% of the population and carries significant rupture risk if undetected. This publication presents the methodology and preliminary results of Slovenia’s national AAA pilot screening program, which examined 280 patients over three months using abdominal ultrasound. Five aneurysms were identified (maximal diameter ≥ 3 cm). The initiative also aims to establish a national AAA patient registry to enable structured follow-up for both patients and their at-risk descendants.

Background: Pathophysiology and Epidemiology of Abdominal Aortic Aneurysm

Abdominal aortic aneurysm (AAA) occurs in approximately 3% of the population and is defined as a permanent, localized dilation of the entire vascular wall exceeding the normal vessel diameter by more than 50%. The pathological basis involves the degradation of elastic fibers within the aortic wall, resulting from a complex interplay of genetic, environmental, and inflammatory factors that progressively weaken the connective tissue of the arterial wall.

The incidence of arterial aneurysms increases with age. In younger patients, aneurysm formation is frequently attributable to genetically determined vascular wall weakness. Among modifiable risk factors, smoking and arterial hypertension are established accelerants of aneurysm progression.

Anatomical Distribution and Diagnostic Thresholds

Aneurysms most commonly affect the abdominal aorta, with the thoracic aorta involved less frequently. The normal diameter of the infrarenal abdominal aorta is generally under 2 cm, varying by sex, age, and body constitution. An infrarenal abdominal aortic aneurysm is conventionally defined when the aortic diameter reaches or exceeds 3 cm; vessels dilated below this threshold are classified as ectatic aortas.

⚠ Rupture risk thresholds: The risk of rupture increases significantly when diameter exceeds 5.5 cm in men and 4.2 cm in women. Additional independent risk factors include female sex (3-fold increased rupture risk), larger diameter at detection, chronic obstructive pulmonary disease severity, arterial pressure, AAA morphology, family history of AAA, and accelerated aneurysm growth rate (Wanhainen et al., 2024).

The clinical significance of AAA lies in its prolonged asymptomatic course: the condition may remain undetected for years, yet carries a high risk of fatal rupture without timely identification and management (Kozak et al., 2015).

Rationale for Systematic AAA Screening in At-Risk Populations

Because most AAAs are detected incidentally, structured screening programs are essential for early detection in high-risk populations. Abdominal ultrasound is the established gold standard for AAA screening. This non-invasive modality offers high diagnostic accuracy, patient safety, and operational simplicity. The examination requires no special preparation, involves no ionizing radiation, and can be completed on an outpatient basis within approximately 10–15 minutes (Kozak et al., 2015).

From a preventive medicine perspective, systematic screening enables early detection, structured surveillance, and elective surgical intervention at a stage when operative risk is acceptably low. Screening programs have been shown to significantly reduce rupture incidence and associated mortality. Furthermore, they provide an opportunity to address modifiable cardiovascular risk factors—including smoking cessation counseling and hypertension management—which can attenuate aneurysm progression (Kozak et al., 2015).

Study Design and Ethical Framework

The Slovenian national society launched a pilot AAA screening program on 1 October 2025. The study received a favorable ethical opinion from the National Medical Ethics Committee on 23 September 2025, confirming both procedural completeness and ethical acceptability of the research protocol (registration no. 0120-443/2025-2711-3).

Data Collection Protocol

For each patient meeting inclusion criteria, structured data were collected before and after the examination using a standardized medical history form and questionnaire. Aortic diameters were obtained via ultrasound at three transverse measurement sites, supplemented by a longitudinal assessment.

Preliminary Results: 280 Patients Over 3 Months

Preliminary Results: 280 Patients Over 3 Months

The mean age of 67.93 ± 34.43 years reflects a predominantly elderly cohort consistent with established AAA epidemiology. The high prevalence of treated hypertension (51.78%) underscores the cardiovascular risk burden of the screened population.

Expansion and Registry: Next Steps

Geographic Expansion to Northeastern Slovenia

Building on the pilot’s initial results, a new application is being submitted to the National Medical Ethics Committee to authorize expansion of the screening program to the northeastern region of the country. Vascular surgeons will be engaged to support both the organizational implementation and clinical assessment components of the expanded program.

Establishment of a National AAA Patient Registry

A secondary objective of the study is the creation of a national registry of patients diagnosed with abdominal aortic aneurysm. The registry aims to systematize long-term follow-up of affected patients and to actively invite their biological descendants—who carry elevated familial risk—to participate in dedicated surveillance and screening protocols.

This strategy is clinically justified by evidence that familial AAA represents a significant risk factor for rupture in younger individuals not typically included in standard screening programs. A structured registry approach has the potential to prevent sudden death in this underserved population (Hultgren et al., 2022).

References

1. Kozak M, et al. (2015). Guidelines on the management of abdominal aortic aneurysm.
2. Wanhainen A, et al. (2024). European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms.
3. Hultgren R, et al. (2022). Familial abdominal aortic aneurysm and implications for screening strategies.

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