Screening for abdominal aortic aneurysm: A consensus statement

Kent, K. Craig; Zwolak, Robert M.; Jaff, Michael R.; Hollenbeck, Scott T.; Thompson, Robert W.; Schermerhorn, Marc L.; Sicard, Gregorio A.; Riles, Thomas S.; Cronenwett, Jack L.

doi:10.1016/j.jvs.2003.08.019

Cited by 194 publications

(100 citation statements)

References 35 publications

(56 reference statements)

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“…25,26 An unambiguous understanding of the risk factors is required for an optimal use of the screening possibilities for prevention. However, regarding the family history no such uniform acceptance seems to exist.…”

Section: Discussionmentioning

confidence: 99%

“…However, regarding the family history no such uniform acceptance seems to exist. The recent screening recommendations for abdominal aneurysms differ on the indication of family history; one recommends screening of men and women older than 50 years with a positive family history, 25 and the other recommends primarily men with a first-degree family history of an abdominal aortic aneurysm requiring surgical repair. 26 Why do the available data not allow a more uniform assessment?…”

Section: Discussionmentioning

confidence: 99%

“…25,26 First, the consideration of the family history should not be limited to abdominal aneurysms, because all aortic aneurysms seem to share the familial risk factors. Yet, the present data lend some support to the higher concordant risks for abdominal aneurysms compared with discordant types.…”

Section: Discussionmentioning

confidence: 99%

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Familial risks of aortic aneurysms among siblings in a nationwide Swedish study

Hemminki

Johansson

et al. 2006

Genetics in Medicine

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Purpose: Aortic aneurysms have a high fatality rate that could be reduced with control of risk factors and use of available screening methods for detection of early changes in aortic walls. The available data on familial risks, a potential indication for screening, are mainly limited to abdominal aortic aneurysms. Methods: A nationwide Standardized incidence ratios (SIRs) were calculated for affected siblings by comparing with those whose siblings had no aneurysm. Results: A total of 71 affected siblings were identified with a familial SIR of 8.71; when one sibling was diagnosed before age 50 years, the SIR was 19.69. For concordant thoracic or concordant abdominal aneurysms, the SIRs were 21.68 and 13.06, respectively. For brothers, the risk of abdominal aneurysms was 14.63, and 49.50 for diagnosis before age 50 years. Familial risks and the effects of early diagnostic age were shared by the anatomic subtypes of aneurysms. Within limits of the sample size, no gender differences could be observed. Affected siblings constituted 2.2% of all diagnosed patients. Conclusions: A family history of any aortic aneurysms and age groups younger than 50 years should be considered in recommendations for screening. The Key Words: familial disease, sibling risk, heritability, screening, population-based Aneurysms are swellings of the blood vessels, and on rupture, they are often fatal. Aneurysms are most common in the abdominal and thoracic parts of the aorta. The lesions in the ascending aorta are often dissections, that is, separations of aortic media that extend to distal segments of the affected vessel. 1-3 The known risk factors for aortic aneurysms include male gender, atherosclerosis, hypertension, smoking, vascular malformations, heritable traits, and family history. 3-5 Atherosclerotic lesions preferentially affect the descending aorta, whereas medial degeneration is the most common lesion in the ascending aorta. 2 Aneurysms are usually a result of a degenerative or an autoimmune disease, including, historically, latestage syphilitic infections. 2,6,7 The pathogenesis of aneurysms involves reduction in elastic compliance of the aortic wall, reduction in medial matrix connective tissue fibers composed of fibrillin, elastin, and collagen, and proneness to progressive damage. 2,3 Important mechanical components in this cascade are extracellular matrix defects, proteolytic enzymes, matrix metalloproteinases capable of degrading elastin and collagen, proteinase inhibitors, and persistent inflammation. 3,5 Marfan syndrome is an autosomal dominant condition in which mutated fibrillin 1 prevents an orderly assembly of the elastic fibers. Dissections are one of the manifestations in this condition. 2 Various types of vascular fragility are also found in excess in one form of Ehlers-Danlos syndrome, which is caused by defects in collagen structure and metabolism. 2,8 Familial clustering of aneurysms is well known, based on anecdotal reports and clinical series, covering both abdominal and thoracic aorta. Some 5% to 20% of th...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Familial risks of aortic aneurysms among siblings in a nationwide Swedish study

Hemminki

Johansson

et al. 2006

Genetics in Medicine

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“…Advanced AAA eventually leads to rupture, which is associated with a mortality of 90% (28). AAA leads to 30,000 deaths every year, of those 15,000 are due to rupture (29,30). The mechanism of AAA involves changes in the aortic wall's extracellular matrix thought to be associated with increased matrix metalloproteinases (MMPs).…”

Section: Clinical Problem and Magnitudementioning

confidence: 99%

Role of molecular imaging with positron emission tomographic in aortic aneurysms

et al. 2017

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Aortic aneurysms (AA) are often asymptomatic before the occurrence of acute, potentially fatal complications including dissection and/or rupture. Beyond aortic size, the ability to assess aortic wall characteristics and processes contributing to aneurysm development may allow improved selection of patients who may benefit from prophylactic surgical intervention. Current risk stratification for aneurysms relies upon routine noninvasive imaging of aortic size without assessing the underlying pathophysiologic processes, including features such as inflammation, which may be associated with aneurysm development and progression. The use of molecular imaging modalities with positron emission tomographic (PET) scan allows characterization of aortic wall inflammatory activity. Elevated uptake of Fuorine-2-deoxy-D-glucose (FDG), a radiotracer with elevated avidity in highly-metabolic cells, has been correlated with the development and progression of both abdominal and thoracic AA in a number of animal models and clinical studies. Other novel PET radiotracers targeting matrix metalloproteinases (MMPs), mitochondrial translocator proteins (TSPO) and endothelial cell adhesion molecules are being investigated for clinical utility in identifying progression of disease in AA. By further defining the activation of molecular pathways in assessing aortic regions at risk for dilatation, this imaging modality can be integrated into future clinical decision-making models.

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“…21 Other professional groups, such as the American College of Cardiology (ACC) and the American Heart Association (AHA), endorse AAA screening among males at risk who are even younger ( ‡50 years old). 22,23 The Society for Academic Emergency Medicine Public Health and Education Task Force (PHTF) stated in 2000 that emergency departments (EDs) should ''provide an opportunity to initiate preventive services for millions of Americans who have no other source for these services.'' 24 The PHTF recommended various prevention, screening, and counseling activities for the ED.…”

mentioning

confidence: 99%

Routine Screening for Asymptomatic Abdominal Aortic Aneurysm in High‐risk Patients Is Not Recommended in Emergency Departments That Are Frequently Crowded

Hoffmann

Bessman

et al. 2009

Academic Emergency Medicine

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Objectives: The objectives were to examine the feasibility of offering abdominal aortic aneurysm (AAA) screening to consecutive, asymptomatic high-risk patients in a busy emergency department (ED) and to compare the prevalence of undetected AAA among ED patients to the prevalence among similarly aged men from the general population.Methods: A prospective cohort study was conducted at an academic community ED with an annual census of 58,000 patients. Dedicated study coordinators attempted to approach all consecutive male ED patients >50 years who presented in June-August 2007 during hours of high patient volume. To be eligible, older males had to have a smoking history or a family history of AAA. Patients were excluded if they presented with AAA symptoms, had a previous history of AAA screening or repair, had hemodynamic instability, or had an altered mental status. Study coordinators completed a brief interview with all enrolled subjects to obtain demographic and health information. A credentialed ED provider performed the ultrasound (US) screening exam and documented all findings. The US director reviewed representative images of the sonographic exam for correct visualization and measurement during quality assurance. The ED sonographers also completed a survey regarding their attitudes toward AAA screening in the ED. The primary study outcomes were the feasibility of AAA screening in the ED (screening rate, enrollment rate, US success rate, and providers' opinions) and the prevalence of AAA (aortic diameter of ‡3.0 cm) in the study sample.Results: During the 12-week study period, the study coordinators successfully approached 96% (700 ⁄ 729) of males > 50 years who were in the ED during study enrollment hours. Of those approached, 278 were eligible (40%), 25% were ineligible, 20% were not at high risk, and for 15% we could not determine risk factor status because of altered mental status. Of the 278 eligible, 196 (70%) underwent an US exam; 10% were not scanned because the providers were too busy, and 20% declined participation. Of those scanned, the ED sonographer was able to completely visualize and correctly measure the abdominal aortas of 71% of subjects. The prevalence rate of AAA in the study sample was 5.7% (95% confidence interval [CI] = 1.9% to 9.6%), similar to reported rates of 6 or 7% in other studies. More than half of the ED sonographers reported that US screening for AAA improved the quality of ED care (58%) and patient satisfaction (63%). However, 47% reported that AAA screening reduced ED efficiency, and 74% felt that the ED was not an appropriate setting for routine AAA screening.Conclusions: Routine screening for asymptomatic AAA required substantial ED resources for a relatively low success rate of completed screens. The prevalence rate of AAA in our ED sample was not significantly different than prevalence estimates obtained from older men in the general population. ED sonographers reported benefits of screening in terms of improving the quality of emergency care and patient satisfa...

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Screening for abdominal aortic aneurysm: A consensus statement

Cited by 194 publications

References 35 publications

Familial risks of aortic aneurysms among siblings in a nationwide Swedish study

Familial risks of aortic aneurysms among siblings in a nationwide Swedish study

Role of molecular imaging with positron emission tomographic in aortic aneurysms

Routine Screening for Asymptomatic Abdominal Aortic Aneurysm in High‐risk Patients Is Not Recommended in Emergency Departments That Are Frequently Crowded

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