Meta-Analysis of the Current Prevalence of Screen-Detected Abdominal Aortic Aneurysm in Women

P Ulug,J.T Powell,M.J Sweeting

doi:10.1016/j.jvs.2016.10.066

Abstract

Current population prevalence of screen-detected abdominal aortic aneurysm (AAA) in older women is subject to wide demographic variation. In patients who have ever smoked and in those aged ≥70 years the prevalence is over 1%.

Highlights

Comment: Use of the screening program varied among regions in the UK with those from less affluent areas and having to travel greater distances making less use of the screening program (Crilly M, et al Br J Surg 2015;102:916-23)
In the UK National Health Service (NHS) abdominal aortic aneurysm (AAA) screening programs are effective in detecting AAA and lead to effectively treating men with AAA
The current study presented here reviews the results of the first 5 years of screening among 65 year old men who had attended an ultrasound screening and the first cohort of men referred for treatment of a large aneurysm over 5.47 cm

Summary

Conclusions

The use of a brachial plexus block (BPB) for performance of upper extremity arteriovenous fistulas improves 3-month primary patency rates. Adults undergoing primary radial cephalic or brachial cephalic arteriovenous fistula creation were randomly assigned 1:1 in blocks of eight using a computer-generated allocation system to receive either local anesthesia (0.5% L-bupivacaine and 1% lidocaine subcutaneously) or regional anesthesia (BPB 0.5% L-bupivacaine and 1.5% lidocaine with epinephrine). Primary patency at 3 months was higher in the BPB group than the local anesthesia group (84% vs 62%; odds ratio, 3.3; 95% confidence interval, 1.4-7.6; P 1⁄4 .005) It was greater in radial cephalic fistulas (77% vs 48%; odds ratio, 3.6 95% confidence interval, 1.4-3.6; P 1⁄4 .03). Functional patency at 3 months was 73% for BPB patients with radial cephalic fistula and 40% with those treated with local anesthesia (P 1⁄4 .02). A necessary additional analysis for many practices in the US will be to determine if anesthetic technique influences the need for secondary procedures to aid fistula maturation

Findings