Chapter 2: Cardiovascular Disorders

ABDOMINAL AORTIC ANEURYSM

Population

• –Men age ≥ 65 y.

Recommendation

USPSTF 2014, ACC/AHA 2006, Canadian Society for Vascular Surgery 2006, Society for Vascular Surgery 2018

• –Screen once before age 75, with ultrasound, if they have ever smoked.

ESVS 2011

• –Screen once with ultrasound at age 65 y if have smoked >100 cigarettes lifetime or have a family history of AAA.

ESVS 2014

• –Screen with ultrasound all men > 65 y of age.

ACRa/AIUM/SRU 2014

• –Screen with ultrasound all men ≥65 y (or ≥50 y with family history of aneurysmal disease) and women ≥ 65 y with cardiovascular risk factors.

• –Patients ≥ 50 y with a family history of aortic and/or peripheral vascular aneurysmal disease.

• –Patients with a personal history of peripheral vascular aneurysmal disease.

• –Groups with additional risk include patients with a history of smoking, hypertension, or certain connective tissue diseases (eg, Marfan syndrome).

• –ACR-AIUM-SRU Practice Parameter for the Performance of Diagnostic and Screening Ultrasound of the Abdominal Aorta in Adults. 2014.

Society for Vascular Surgery 2018

• –Screen once with ultrasound between age 65 and 75 if ever smoked, or after 75 if in “good health” and never screened previously.

Sources

• –Ann Intern Med. 2014;161(4):281-290.

• –J Vasc Surg. 2007;45:1268-1276.

• –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.

• –Erbel R, Aboyans V, Boileau C, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J. doi:10.1093/eurheartj/ehu281

• –ACR-AIUM-SRU Practice Parameter for the Performance of Diagnostic and Screening Ultrasound of the Abdominal Aorta in Adults. 2014.

• –J Vasc Surg. 2018;67(1):2-77.

Population

• –Men/women at high risk.

Recommendations

Canadian Society for Vascular Surgery 2008

• –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.

Source

• –Can J Surg. 2008;51(1):23-34.

Population

• –Women age ≥65 y.

• –Abdominal echocardiography used for mass screening in subgroups at risk was associated with a significant 45% decreased risk of AAA-related mortality at 10 y.

CAROTID ARTERY STENOSIS (CAS) (ASYMPTOMATIC)

Population

• –Asymptomatic adults.

Recommendations

ASN 2007, USPSTF 2014, AHA/ASA 2011, ACCF/ACR/AIUM/ASE/ASN/ICAVL/SCAI/SCCT/SIR/SVM/SVS 2011, AAFP 2013

• –Do not screen the general population or ...