TY  - CHAP
M1  - Book, Section
TI  - Abdominal Aortic Aneurysm (AAA) Screening
A1  - Altkorn, Diane
A1  - Schulwolf, Elizabeth
A2  - Stern, Scott D.C.
A2  - Cifu, Adam S.
A2  - Altkorn, Diane
Y1  - 2020
N1  - 
T2  - Symptom to Diagnosis: An Evidence-Based Guide, 4e
AB  - 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    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  have  a  positive  family  history  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2025/03/21
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1185661766
ER  -