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ABDOMINAL AORTIC ANEURYSM

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ABDOMINAL AORTIC ANEURYSM
Disease Screening Organization Date Population Recommendations Comments Source
Abdominal Aortic Aneurysm (AAA)

USPSTF

ACC/AHA

Canadian Society for Vascular Surgery

2014

2006

Men age 65–75 y who have ever smoked

One-time screening for AAA by ultrasonography.

No recommendation for or against screening for AAA in men age 65–75 y who have never smoked.

  1. Cochrane review (2007): Significant decrease in AAA-specific mortality in men (OR, 0.60, 95% CI 0.47–0.99) but not for women. (Cochrane Database Syst Rev. 2007;2:CD002945; http://www.thecochranelibrary.com)

  2. Early mortality benefit of screening (men age 65–74 y) maintained at 7-y follow-up. Cost-effectiveness of screening improves over time. (Ann Intern Med. 2007;146:699)

  3. Surgical repair of AAA should be considered if diameter ≥5.5 cm or if AAA expands ≥0.5 cm over 6 mo to reduce higher risk of rupture. Meta-analysis: endovascular repair associated with fewer postoperative adverse events and lower 30-d and aneurysm-related mortality but not all-cause mortality compared with open repair. (Br J Surg. 2008;95(6):677)

  4. Asymptomatic AAA between 4.4 and 5.5 cm should have regular ultrasound surveillance with surgical intervention when AAA expands >1 cm y or diameter reaches 5.5 cm. (Cochrane Database Syst Rev. 2008, CD001835; http://www.thecochranelibrary.com)

  5. Medicare covers one-time limited screening.

http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/abdominal-aortic-aneurysm-screening

J Vasc Surg. 2007;45:1268-1276

Canadian Society for Vascular Surgery 2008 Men/women at high risk

All men age 65–75 be screened for AAA.

Individual selective screening for those at high risk for AAA:

  1. Women older than age 65 at high risk secondary to smoking, cerebrovascular disease, and family history

  2. Men younger than 65 with positive family history

Circulation. 2006;113(11): e463-e654

J Vasc Surg. 2007;45:1268-1276

Can J Surg. 2008;51(1):23-34

USPSTF 2014 Women who have never smoked Routine screening is not recommended. http://www.medicare.gov/coverage/ab-aortic-aneurysm-screening.html
UPSTF Women ages 65–75 y who have ever smoked The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA in women ages 65 to 75 y who have ever smoked.
CMS 2015 Men age 65–75 y who have smoked at least 100 cigarettes in their lifetime or people at risk who have a family history of AAA Recommend one-time ultrasound screening for AAA.
ESVS 2011 Men should be screened with a single scan at age 65 y. Screening should be considered at an earlier age in those at higher risk for AAA. Moll FL, Powell JT, Fraedrich G, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg. 2011;(41):S1-S58
ESC 2014

Male> 65 y

Female > 65 y

Ultrasound screening is recommended in all men > 65 y of age.

Ultrasound screening may be considered if history of current/past smoking is present. It is not recommended in female non-smokers without family history of AAA.

Targeted screening for AAA with ultrasound should be considered in first-degree siblings of a patient with AAA.

Abdominal echocardiography used for mass ...

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