Abdominal Aortic Aneurysm Screening Criteria: Time for Expansion to Save More Lives?

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Ruptured abdominal aortic aneurysms (AAA) cause an estimated 15,000 deaths per year in the United States, 5,000 to 8,700 in the United Kingdom, and 5,000 in Brazil. AAA incidences increase in individuals over 50 years of age, and approximately twice as many men as women experience AAA.

Because abdominal aortic aneurysms can grow slowly without symptoms, they are difficult to detect. They can start and stay small, or expand rapidly after years of slow growth. Physicians typically order an abdominal ultrasound, CT scan, or MRI for patients presenting with abdominal or back pain, and/or a pulsing sensation near the belly button to detect the condition of the aorta.

Often, the first indication of an AAA is a rupture, a dramatic event causing rapid internal bleeding impeding blood flow to the heart and brain. Mortality rates can be as high as 80%. Screening programs based on various risk factors are helping to reduce mortality rates and financial impacts to hospitals, families, healthcare systems, and society.

 

AAA screening guidelines

Several players worldwide provide AAA screening guidelines, some more rigorous than others.

The US Preventive Services Task Force (USPTF) is one of the more influential organizations creating guidelines. In its 2019 update of 2014 guidelines, the USPTF published the following recommendations:

Routine Screenings
Asymptomatic men 65 to 75 years who have smoked at any time in their life.

Selective - based on doctor input
Asymptomatic men 65 to 75 who have never smoked.

Against Screenings
Asymptomatic women who have never smoked and have no family history of AAA.

Insufficient evidence for definitive recommendation
Asymptomatic women who have ever smoked.

The European Society of Cardiology, on the other hand, recommends:

Routine Screenings

  • All men over 65 years of age
  • Men and women with lower extremity artery disease
  • Men and women 50 years and older with a first degree relative with an AAA
  • Men and women presenting with aortic aneurysm at any location or peripheral (iliac, femoral, popliteal)

Selective Screenings

  • Women free of smoking history, lower extremity artery disease, relatives with AAA, aortic or peripheral aneurysms

Faulting the USPSTF guidelines as too limited, the Society for Vascular Surgery has even more robust recommendations. Theirs include:

Routine Screenings

  • Men and women 65 to 75 with a history of smoking
  • Men and women with first degree relatives with AAA

One-time Screening
Men or women older than 75 years with a history of tobacco use who have not previously received a screening ultrasound examination

 

Expanded AAA screening criteria can save lives

Robust research is pointing to the life-saving potential of expanded criteria.

Albert Einstein College of Medicine cardiologist Matthew L. Carnevale, MD, et al conducted a retrospective cohort analysis to identify patients who would have met criteria for AAA screening using both the United States Preventive Services Task Force (USPSTF) and Society for Vascular Surgery (SVS) guidelines. He and colleagues studied 55,197 patients undergoing AAA repair in the Vascular Quality Initiative. Of these, 44,602 patients underwent endovascular aneurysm repair (EVAR) and 10,595 patients underwent open repair.

They discovered:

  • Fewer than one-third of patients would have been identified using only USPSTF criteria
  • When adding SVS criteria, numbers of identified patients increased by 34% for EVA and 33% for open repair
  • 28% of patients who ended up needing AAA repair had not met either USPSTF or SVS screening criteria
  • Ruptured AAA occurred twice as often in patients who did not meet any screening criteria as compared with those who did meet screening criteria (8.5% vs 4.4%).

Given this research and more, SVS estimates that expanding USPSTF screening guidelines to include women smokers and those delineated above could double the number of patients identified with AAA. When rupture is so often fatal, of course identifying these patients early enables doctors to monitor the AAA. Most choose not to operate, however, until the aneurysm is larger than 3 cm, however.

Screening criteria vary by country, facility, and payment system. Entities that choose to expand screening criteria stand to improve patient outcomes. After all, the cost of screening is low, particularly when compared to the gratitude from patients and their families exhibit when doctors catch a life-threatening issue. Finally, with morbidity and mortality following elective repair rates low, facilities have little to lose in undertaking more, rather than fewer, AAA screenings.

 

Successful TAAA surgeries rely on precision diagnosis, treatment, and equipment

Screenings are just the first step to winning the best outcomes in abdominal aortic aneurysm (AAA) and thoracoabdominal aortic aneurysms (TAAA) cases. With the vast majority of such surgeries resulting in positive outcomes, hospitals, doctors and staff must ensure recovery goes smoothly.

Integral to successful TAAA surgery aftermath is the proper drainage of cerebrospinal fluid.

During a TAAA procedure, cross‐clamping interrupts the blood supply to the spinal cord. Cerebrospinal fluid drainage from the lumbar region must be managed so that blood can flow to the spinal cord, avoiding spinal cord injury risks. Surgeons utilizing appropriate CSF drainage equipment during TAAA are more likely to avoid catastrophic outcomes.

To ensure success in delicate TAAA procedures, cardio vascular seek out the most sophisticated, proven CSF management equipment. For decades now, MÖLLER has supplied the world’s most sophisticated German-engineered, cerebrospinal fluid drainage equipment. The most current iteration, LiquoGuard® 7, maximizes drainage safety, keeps treatment costs under control, and ensures quick patient mobility post-surgery (key for healthy recovery.) LiquoGuard® 7 is the pioneering oder revolutionary CSF management system that simultaneously drains and measures CSF pressure.

To learn more about LiquoGuard® 7, its convenient accessories, and the surgical instruments that will help you achieve optimal surgical outcomes or if you have any questions, contact us at 0049 661 - 94195 0.

 

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