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Chapter 1

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ABDOMINAL AORTIC ANEURYSM

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Population

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  • –Men age 65–75 y who have ever smoked.

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Recommendations

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USPSTF 2014, ACC/AHA 2006, Canadian Society for Vascular Surgery 2006

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  • –Screen once, with ultrasounography.

  • –In men in this age group who have never smoked, no recommendation for or against screening.

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 Sources

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  • Ann Intern Med. 2014;161(4):281-90

  • J Vasc Surg. 2007;45:1268-1276

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Population

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  • –Men/women at high risk.

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Recommendations

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Canadian Society for Vascular Surgery 2008

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  • –All men age 65–75 y be screened for AAA.

  • –Individual selective screening for those at high risk for AAA:

    1. Women older than 65 y at high risk secondary to smoking, cerebrovascular disease, and family history.

    2. Men younger than 65 y with positive family history.

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Source

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  • Can J Surg. 2008;51(1):23-34

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Population

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  • –Women who have never smoked.

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Recommendation

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USPSTF 2014

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  • –Routine screening is not recommended.

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Source

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  • Ann Intern Med. 2014;161(4):281-90

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Population

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  • –Women age 65–75 y who have ever smoked.

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Recommendation

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UPSTF 2014

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  • –Current evidence is insufficient to assess the balance of benefits and harms.

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Source

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  • Ann Intern Med. 2014;161(4):281-90

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Population

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  • –Men age 65–75 y who have smoked at least 100 cigarettes in their lifetime or people at risk who have a family history of AAA.

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Recommendation

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ESVS 2011

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  • –Men should be screened with a single scan at age 65 y. Screening should be considered at an earlier age in those at higher risk for AAA.

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Source

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  • –Moll FL, Powell JT, Fraedrich G, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg. 2011;(41):S1-S58

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Comments

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  1. Cochrane review (2007): Significant decrease in AAA-specific mortality in men (OR, 0.60, 95% CI 0.47–0.99) but not for women. (Cochrane Database Syst Rev. 2007;2:CD002945; http://www.thecochranelibrary.com)

  2. Early mortality benefit of screening (men age 65–74 y) maintained at 7-y follow-up. Cost-effectiveness of screening improves over time. (Ann Intern Med. 2007;146:699)

  3. Surgical repair of AAA should be considered if diameter ≥5.5 cm or if AAA expands ≥0.5 cm over 6 mo to reduce higher risk of rupture. Meta-analysis: endovascular repair associated with fewer postoperative adverse events and lower 30-d and aneurysm-related mortality but not all-cause mortality compared with open repair. (Br J Surg. 2008;95(6):677)

  4. Asymptomatic ...

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