Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ What is the burden of disease? 4–8% of older men and 0.5–1.5% of older women have an AAA. AAA accounts for about 9000 deaths per year in the United States. 1-year rupture rates are 9% for AAAs 5.5–5.9 cm, 10% for 6–6.9 cm, and 33% for AAAs ≥ 7 cm. Only 10–25% of patients with ruptured AAA survive to hospital discharge. Is it possible to identify a high-risk group that might especially benefit from screening? Age > 65, ever smoking (≥ 100 lifetime cigarettes), male sex, and family history are the strongest risk factors for an AAA > 4.0 cm. The OR increases by 1.7 for each 7-year age interval. Current or past smoking increases the risk of AAA by 3–5. The prevalence of AAA increases more rapidly with age in ever smokers than in never smokers. The prevalence of AAA > 4 cm in never smokers is < 1% for all ages. The OR is 1.94 for a positive family history. The OR is ~1.3–1.5 for history of coronary artery disease, hypercholesterolemia, or cerebrovascular disease. The OR is 0.53 for black persons and 0.52 for patients with diabetes. What is the quality of the screening test? Ultrasonography has a sensitivity of 94–100% and specificity of 98–100% for the detection of AAA, defined as an infrarenal aortic diameter > 3.0 cm. One-time screening is sufficient since cohort studies of repeated screening have shown that over 10 years, the incident rate for new AAAs is 4%, with a few AAAs of > 4.0 cm found. Abdominal palpation is not reliable. Does screening reduce morbidity or mortality? A meta-analysis of 4 randomized controlled trials of screening for AAA in men showed a reduction in mortality from AAA, with a pooled OR of 0.50 over 13–15 years. Overall in-hospital mortality for open AAA repair is 4.2%; lower mortality is seen in high-volume centers performing > 35 procedures/year (3% mortality vs 5.5% in low-volume centers) and when vascular surgeons perform the repair (2.2% for vascular surgeons, 4.0% for cardiac surgeons, 5.5% for general surgeons). 30-day postoperative mortality is higher with open repair than with endovascular repair (2% absolute risk increase, number needed to harm = 50). There are no differences in long-term all-cause mortality or cardiovascular mortality, or in rates of stroke; therefore, endovascular repair is preferred. There was no reduction in all-cause mortality, or in AAA-specific mortality in women. What are the current guidelines? USPSTF (2014) Grade B recommendation for one-time screening by ultrasonography in men age 65–75 who have ever smoked (moderate net benefit) Grade C recommendation to selectively screen men ages 65–75 years who have never smoked (small net benefit) No recommendation (Grade I) for women ages 65–75 who have ever smoked (insufficient evidence to determine balance of benefits and harms) Grade D recommendation to not screen women who have never smoked (harms outweigh benefits) Society of Vascular Surgery (2009) One-time screening for all men over 65 (at 55 if family history is positive) One-time screening for women over 65 who have smoked or ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.