Aortic Aneurysm, Abdominal

EVIDENCE-BASED ANSWER:
LIKELY YES. POINT-OF-CARE ULTRASOUND (POCUS) SCREENING FOR ABDOMINAL AORTIC ANEURYSM (AAA) BY NONRADIOLOGIST PHYSICIANS IS 98% SENSITIVE AND 99% SPECIFIC, COMPARED WITH IMAGING PERFORMED BY RADIOLOGISTS (STRENGTH OF RECOMMENDATION [SOR]: B, META-ANALYSIS OF DIAGNOSTIC ACCURACY STUDIES MOSTLY INVOLVING EMERGENCY MEDICINE PHYSICIANS). EUROPEAN FAMILY PHYSICIANS DEMONSTRATED 100% CONCORDANCE WITH RADIOLOGIST READINGS (SOR: C, VERY SMALL SUBSEQUENT DIAGNOSTIC ACCURACY STUDIES).

Author/s:

Cade, N., Granath, B., Nether, J. O., Safranek, S.

Final Update Summary: Abdominal Aortic Aneurysm: Screening

John Bayhi — Wed, 11 Dec 2019 18:57:40 +0000

Date Added:

December 11, 2019

Journal/Publication:

USPSTF Website

Publisher:

USPSTF Program Office

Publication Date:

December 1, 2019

URL:

Screening for Abdominal Aortic Aneurysm: US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2019.18928

Keywords

abdominal aortic aneurysm

PMID (1):

31821437

MeSH

Aortic Aneurysm, Abdominal

smoke

prevalence

Achalasia Addisonianism Alacrimia syndrome

Updated USPSTF recommendations regarding screening for AAA. James W. Mold, MD, MPH

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IMPORTANCE:

An abdominal aortic aneurysm (AAA) is typically defined as aortic enlargement with a diameter of 3.0 cm or larger. The prevalence of AAA has declined over the past 2 decades among screened men 65 years or older in various European countries. The current prevalence of AAA in the United States is unclear because of the low uptake of screening. Most AAAs are asymptomatic until they rupture. Although the risk for rupture varies greatly by aneurysm size, the associated risk for death with rupture is as high as 81%.

OBJECTIVE:

To update its 2014 recommendation, the USPSTF commissioned a review of the evidence on the effectiveness of 1-time and repeated screening for AAA, the associated harms of screening, and the benefits and harms of available treatments for small AAAs (3.0-5.4 cm in diameter) identified through screening.

POPULATION:

This recommendation applies to asymptomatic adults 50 years or older. However, the randomized trial evidence focuses almost entirely on men aged 65 to 75 years.

EVIDENCE ASSESSMENT:

Based on a review of the evidence, the USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have ever smoked is of moderate net benefit. The USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have never smoked is of small net benefit. The USPSTF concludes that the evidence is insufficient to determine the net benefit of screening for AAA in women aged 65 to 75 years who have ever smoked or have a family history of AAA. The USPSTF concludes with moderate certainty that the harms of screening for AAA in women aged 65 to 75 years who have never smoked and have no family history of AAA outweigh the benefits.

RECOMMENDATIONS:

The USPSTF recommends 1-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked. (B recommendation) The USPSTF recommends that clinicians selectively offer screening for AAA with ultrasonography in men aged 65 to 75 years who have never smoked rather than routinely screening all men in this group. (C recommendation) The USPSTF recommends against routine screening for AAA with ultrasonography in women who have never smoked and have no family history of AAA. (D recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA with ultrasonography in women aged 65 to 75 years who have ever smoked or have a family history of AAA. (I statement).

Author/s:

U. S. Preventive Services Task Force

Draft Recommendation Statement, Abdominal Aortic Aneurysm: Screening

Brian Desmarais — Wed, 10 Jul 2019 00:09:42 +0000

Date Added:

July 9, 2019

Publisher:

U.S. Preventive Services Task Force

Publication Date:

July 15, 2019

URL:

Draft Recommendation Statement, Abdominal Aortic Aneurysm: Screening

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

Keywords

tobacco

smoke

ultrasonography

MeSH

Aortic Aneurysm, Abdominal

smoke

Ultrasonography

tobacco

The USPSTF recommends screening male smokers between 65 and 75 for AAA with ultrasound (B recommendation) and offering screening to selected male non-smokers 65 to 74 after discussing benefits and hazards.

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Draft: Recommendation Summary

Population
Recommendation
Grade
(What's This?)

Men ages 65 to 74 years who have ever smoked

The USPSTF recommends one-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men ages 65 to 75 years who have ever smoked.

Men ages 65 to 75 years who have never smoked

The USPSTF recommends that clinicians selectively offer screening for AAA with ultrasonography in men ages 65 to 75 years who have never smoked rather than routinely screening all men in this group. Evidence indicates that the net benefit of screening all men in this group is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of evidence relevant to the patient’s medical history, family history, other risk factors, and personal values.

Women who have never smoked with no family history

The USPSTF recommends against routine screening for AAA with ultrasonography in women who have never smoked and have no family history.

Women ages 65 to 75 years who have ever smoked or have a family history

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA with ultrasonography in women ages 65 to 75 years who have ever smoked or have a family history.