Feasibility and diagnostic validity of abdominal aortic aneurysm screening in Hungarian primary care: a multiregional pilot study

Figures

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  FIGURE 1. Study flowchart of GP participation, patient screening, and outcomes of AAA screening examinations. After training, a subset of GPs contributed to patient recruitment and US assessments. The majority of examinations were suitable for analysis following expert validation. Most patients demonstrated normal abdominal aortic findings, while a smaller proportion showed pathological changes, including ectasia and aneurysm. Abdominal aortic ectasia was defined as an aortic diameter of 25.0–29.9 mm. Cases identified with aneurysmal dilation were subsequently managed either by referral for surgical intervention or by scheduled follow-up. AAA, abdominal aortic aneurysm; GP, general practitioner.

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  FIGURE 2. Relationship between screening volume and mean examination time among GPs. Each point represents an individual GP. In this exploratory operator-level analysis, a strong negative correlation was observed between the number of screening examinations performed and mean examination time, suggesting shorter examination times with increasing operator experience. Because the analysis included only 11 GPs, this finding should be interpreted cautiously and considered hypothesis-generating.

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  FIGURE 3. Distribution of abdominal aortic diameters across aortic segments stratified by sex and smoking status. (A) (Upper) shows the distribution of segmental abdominal aortic diameters stratified by sex, while (B) (Lower) presents the same distribution stratified by smoking status. Within each panel, measurements are grouped by aortic segment (proximal, mid, and distal). Each point represents an individual segmental measurement obtained during ultrasound screening performed by GPs. Points are color-coded according to aortic diameter category: normal (<25 mm), ectasia (25–29.9 mm), and abdominal aortic aneurysm (≥30 mm). Vertical dashed lines indicate clinically relevant threshold values for ectasia and aneurysm. For each segment, the larger of the anteroposterior and transverse diameters was used for analysis. Normal aortic measurements are shown as white markers with black borders, ectasia is shown with yellow markers, and abdominal aortic aneurysm is shown with red markers.