Recommendation:
Ø The USPSTF
recommends 1-time screening for Abdominal Aortic Aneurysm (AAA) with
ultrasonography in men aged 65 to 75 years who have ever smoked (B
recommendation)
Ø The USPSTF
recommends that clinicians selectively offers screening for AAA in men aged 65
to 75 years who have never smoked (C recommendation)
Ø The USPSTF
concludes that the current evidence is insufficient to assess the balance of
benefits and harms of screening for AAA in women aged 65 to 75 years who have
ever smoked (I statement)
Ø The USPSTF
recommends against routine screening for AAA in women who have never smoked (D
recommendation)
Risk factor for
AAA include older age, a positive smoking history, having a first-degree
relative with an AAA; and having history of other vascular aneurysms, coronary
artery disease, cerebrovascular disease, atherosclerosis, hypercholesterolemia,
obesity, or hypertension.
Factor associated
with a reduced risk for AAA include African American race, Hispanic ethnicity,
and diabetes.
Abdominal duplex
ultrasonography is the standard approach for AAA screening. Screening with
ultrasonography is noninvasive and easy to perform and has high sensitivity (94
% t0 100%) and specificity (98 % to 100 %) for detection.
Patient with
large AAA (> or = 5.5 cm) are referred for open surgical repair or
endovascular aneurysm repair. Patient with smaller aneurysm (3.0 to 5.4 cm) are
generally managed conservatively via surveillance (repeated ultrasonography
every 3 to 12 mo).
Early open
surgery for the treatment of smaller AAAs does not reduce AAA-specific or
all-cause mortality. Surgical referral of smaller AAAs is typically reserved
for rapid growth (>1.0 cm per year) or once the threshold of > 5.5 cm on
repeated ultrasonography is reached.
Short-term
treatment with antibiotics or B-blockers does not seem to reduce AAA growth.
Bibliography
LeFevre, M. L. (2014, Aug 18). Screening for
Abdominal Aortic Aneurism: U.S. Preventive Services Task Force Recommendation
Statement. Ann of Int Med, ;161(4):281-291. Retrieved from Annals of
Internal Medicine: http://annals.org
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