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A large AAA screening program at the VA detects more aneurysms, but at smaller diameters than that published in clinical trials. Over time, the number of inappropriate AAA screenings has continued to decrease, demonstrating greater awareness and application of the AAA screening guidelines by primary care providers. Developing surveillance guidelines for small and medium aneurysms is a potential area for future research.

If this same tendency prevails in other prospective studies, we strongly believe that prophylactic excision of all nevus sebaceus is not warranted. Excision should be recommended only when benign or malignant neoplasms are clinically suspected or for cosmetic considerations.

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Objective Surveillance of patients identified with small abdominal aortic aneurysm (AAA) from an AAA screening program poses a challenge for health systems due to numerous patient follow-ups. This study evaluates the surveillance outcomes of patients identified with small AAA from a large screening program. Methods A retrospective chart review of all patients screened for small AAA (3.0 – 5.4 cm) from 2007–2011 was conducted. Patients with small AAA and no previous history of repair were tracked for follow-up using the 2013 RESCAN follow-up guidelines according to aortic diameter: (3.0 – 3.9 cm, 3 years; 4.0 –4.4 cm, 2 years; 4.5 – 5.4 cm, 1 year). Socioeconomic factors including marital status, distance to hospital from residence, estimated household income, and employment disability status that may influence the follow-up rate and all-cause mortality after screening were also evaluated. Results A total of 568 patients (mean±stdev: 73.4±7.2 years old) with small AAA (3.6±0.6 cm) were analyzed. Patient follow-up rate was 65.1% (n=370/568). Reasons for follow-up failure were: lack of physician ordering scan (n=139, 70.2%), delayed ordering of scans (n=36, 18.2%), patient no-show (n=18, 9.1%), or patient death prior to follow-up (n=5, 2.5%). Of all patient-specific factors, patients with smaller diameters were unlikely to achieve follow-up scans (p<.001). A significantly higher risk of all-cause mortality was found for patients with no ultrasound follow-up scan (hazard ratio, p-value: 0.369, p<0.001), assisted living (0.381, p<0.001), older age (1.04, p=0.001), and lower household incomes (0.989, p=0.01). Conclusions The follow-up rate of small AAA patients was poor at 65.1%. The data indicate that socioeconomic factors do not significantly affect follow-up success. Therefore, physician ordering of scans may exert the greatest influence on follow-up rates in patients with small AAA. Automatic ordering of follow-up scans for small AAA patients is proposed to improve follow-up rates.

Objective: In 2007, Medicare established ultrasound screening guidelines to identify patients at risk for abdominal aortic aneurysm (AAA). The purpose of this study was to evaluate AAA diagnosis rates and compliance with screening during 10 years (2007-2016) of the Screen for Abdominal Aortic Aneurysms Very Efficiently Act implementation within a regional health care system. Methods: A retrospective chart review of all patients screened for AAA from 2007 to 2016 within a regional Veterans Affairs health care system was conducted. Screening criteria were men 65 to 75 years of age who smoked a minimum of 100 cigarettes in their lifetime. An AAA was defined as a maximum aortic diameter ≥3 cm. A comparison was made of the AAA diagnosis rate and clinical adherence rate of screening criteria between the first 5 years and total years evaluated. AAA-related mortality was identified by using terminal diagnosis notes or autopsy reports. All data were recorded by August 31, 2017.

Objective Statin therapy is utilized in the medical management of patients with peripheral vascular disease (PVD) and abdominal aortic aneurysm (AAA) for the pleiotropic and anti-inflammatory benefits. We hypothesize that the inflammatory mechanisms of monocyte-endothelial cell interactions in endothelial barrier dysfunction is more significant in patients with PVD compared to AAA. The purpose of this study is to assess patient peripheral blood monocyte adhesion molecules by flow cytometry and monocyte-induced endothelial barrier dysfunction by using an in vitro endothelial cell layer and electric cell-substrate impedance sensing system (ECIS). Methods Peripheral blood was collected from patients with either PVD (ABI<0.9, toe-arm index <0.8, or required lower extremity vascular intervention) or AAA (aortic diameter >3.0 cm). Monocytes were isolated from fresh whole blood using an accuspin-histopaque technique. The separated monocytes underwent flow cytometry analysis to evaluate expression levels of the cell membrane adhesion molecules: CD18, CD11a/b/c, and VLA-4. Endothelial cell function was assessed by adding monocytes to an endothelial monolayer on ECIS arrays and co-culturing overnight. Peak changes in trans-endothelial resistance were measured and compared between patient groups. Results Twenty-eight monocyte samples were analyzed for adhesion molecules (PVD: 19, AAA: 9) via flow cytometry and 11 patients were evaluated for endothelial dysfunction (PVD: 7, AAA: 4) via ECIS. There was no significant difference between risk factors among PVD and AAA patients except for age, where AAA patients were significantly older than PVD patients in both flow cytometry and ECIS groups (P=0.02, 0.01 respectively). There were significantly higher levels of adhesion molecules CD11a, CD18, and CD11c (averaged MFI P-values: 0.047, 0.038, 0.014, respectively) in PVD patients compared to AAA patients. No significant difference was found for CD11b and VLA-4 expression (P=0.21, 0.15 respectively). There was significantly more monocyte-endothelial cell dysfunction as a result of monocytes obtained from patients with PVD than from AAA, with a maximal effect seen at 15 hours after monocyte addition (P=0.032). Conclusions Patients with PVD have increased expression levels of certain monocyte adhesion molecules and greater monocyte-induced endothelial layer dysfunction when compared to patients with AAA. This may lead to other methods of targeted therapy to improve outcomes of these vascular patients.

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