Society for Vascular Surgery implementation of clinical practice guidelines for patients with an abdominal aortic aneurysm: Screening for an abdominal aortic aneurysm

Abstract

•High morbidity and mortality associated with abdominal aortic aneurysm (AAA) rupture.•Most effective mechanism to prevent death from rupture is the prevention of rupture itself.•Ultrasound based abdominal screening, in multiple randomized controlled clinical trials,1Cosford P.A. Leng G.C. Screening for abdominal aortic aneurysm.Cochrane Database Syst Rev. 2007; : CD002945PubMed Google Scholar associated with:○40% reduction aneurysm-related mortality○50% reduction in aneurysm rupture•AAA prevalence, growth and rupture are most strongly predicted by smoking history.•First-degree relatives of patients with AAA have approximately 20% likelihood for AAA development. Consider one-time ultrasound screening for AAA in:•Men and women aged 65 to 75 with a history of tobacco use (Grade 1A).•Men and women older than 75 in good health with history of tobacco use and not previously screened (Grade 2C).•First-degree relatives aged 65 to 75 or older than 75 in good health of patients presenting with AAA (Grade 2C).2Chaikof E.L. Dalman R.L. Eskandari M.K. Jackson B.M. Lee W.A. Mansour M.A. et al.The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm.J Vasc Surg. 2018; 67: 2-77.e2Abstract Full Text Full Text PDF PubMed Scopus (783) Google Scholar •Lower AAA prevalence in women balanced by estimated fourfold higher rupture rate and quicker progression to rupture than men (Fig).3Ulug P. Powell J.T. Sweeting M.J. Bown M.J. Thompson S.G. Group S.C. Meta-analysis of the current prevalence of screen-detected abdominal aortic aneurysm in women.Br J Surg. 2016; 103: 1097-1104Crossref PubMed Scopus (52) Google Scholar•A contemporary review estimates a 1.34% pooled prevalence of AAA in women over age 60 with a history of tobacco use, with evidence suggesting selective screening of women is cost effective beyond a threshold prevalence of 1%.2Chaikof E.L. Dalman R.L. Eskandari M.K. Jackson B.M. Lee W.A. Mansour M.A. et al.The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm.J Vasc Surg. 2018; 67: 2-77.e2Abstract Full Text Full Text PDF PubMed Scopus (783) Google Scholar,3Ulug P. Powell J.T. Sweeting M.J. Bown M.J. Thompson S.G. Group S.C. Meta-analysis of the current prevalence of screen-detected abdominal aortic aneurysm in women.Br J Surg. 2016; 103: 1097-1104Crossref PubMed Scopus (52) Google Scholar •Despite Medicare SAAAVE Act in 2007, less than 15% of eligible patients undergo AAA screening.•Consider implementing a primary care clinical alert in the electronic health record prompting an order set or mailed screening invitations for patients that meet screening criteria and include in the subsequent ultrasound report a standardized algorithm for further surveillance and management.5Hye R.J. Smith A.E. Wong G.H. Vansomphone S.S. Scott R.D. Kanter M.H. Leveraging the electronic medical record to implement an abdominal aortic aneurysm screening program.J Vasc Surg. 2014; 59: 1535-1542Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar