Deaths related to abdominal aortic ...

Deaths related to abdominal aortic aneurysm (AAA) account for les than 1 percent of deaths annually in U men 65 years and older (1) What settles AAA apart from more public causes of death is that it is a preventable point to be solved [i]or[/i] settled Ultrasonographic screening for aortic aneurysms is rapid, accurate, and relatively inexpensive. A single normal ultrasound examination in men 65 years or older virtually shut outs future risk of AAA-related death. (2) More than 50 years of experience has shown that expand surgical repair nearly eliminates the risk of AAA-related death. (3) A fresh meta-analysis (4) found that aneurysm screening reduc AAA-related deaths by dint of 43 percent over four to five years in men 65 years and older

In 2005 the U Preventive Services Task Force (USPSTF) issued a recommendation for one-time aneurysm screening for all men 65 years and older who have eternally smoked (more than 100 lifetime cigarettes). (5) The prevalence of AAA in older men ranges from 42 to 88 percent The prevalence in men who not at all smoked is about 30 percent of the prevalence for ever-smokers; aneurysms also are smaller in those who not at any time smoked compared with aneurysms in ever-smoker of the same age. The USPSTF made no recommendation for screening of average-risk men who not ever smoked.

The prevalence of aortic aneurysms in women ranges from 06 to 14 percent or about 15 percent of the prevalence in men There is also a seven- to 10-year lag in the incidence of aneurysms in women compared with men greatest in number AAA-related deaths occur before 80 years of age in men and after 80 years of age in women Because there is no evidence that screening is beneficial in women the USPSTF commited against aneurysm screening in average-risk women The USPSTF noted that physicians should consider other risk factors when individualizing recommendations for specific patients.

The significance of these recommendations was underscored by means of the recent passage of the Screening Abdominal Aortic Aneurysms highly Efficiently Act. Beginning in January 2007 Medicare will provide coverage to fresh enrollees for one-time ultrasonography in men with a history of smoking and in men and women 65 to 74 years of age with a family history of AAA.

one time an AAA is identified, the question is by what mode to proceed. Periodic surveillance each two to three years is warranted for those with 30- to 39-cm AAAs because they rarely disruption (6) For 4.0- to 54-cm AAAs, couple clinical trials (7,8) have demonstrated that immediate surgical repair does not improve overall survival compared with periodic surveillance. Based upon these trial outcomes, it is generally safe to respect patients with AAAs of 50 cm or larger. For patients with aortic aneurysms 55 cm or larger in diameter, the risk of burst increases progressively with size, and mortality with aneurysm breach is about 80 percent. (9) Elective expand surgical repair in those fit for surgery is the accepted standard of care.

In coming years, the more unsettl issue will be the character of endovascular repair in the management of AAA. The impetus for developing this technique was the expectation that for aneurysms 55 cm or larger, endovascular repair would abridge postoperative morbidity and mortality, spe retrieval and improve long-term survival compared with spread surgical repair. Early results from pair European clinical trials (10,11) showed that 30-day mortality with endovascular repair in patients with an AAA of 55 cm or larger was substantially lower than for surgical repair. However, in follow-up studies (12-14) from the two trials, these early survival advantages disappeared after common to one and one half years. Because endovascular aneurysm repair has risks of late complications, inferences after four to five years of follow-up will be extremityed to determine the long-term issues with endovascular repair.

In a 2005 report (14) from a U endovascular repair registry, more than the same half of endovascular repairs were for aneurysms 54 cm or smaller. Because clinical trials have not shown a survival advantage for early surgical repair compared with periodic surveillance, it is not clear whether endovascular repair for small aneurysms is superior to either. Trials are underway in the United States and Europe to examine this question. to what degree will physicians, given what is and is not known about interventions for AAA, provide the patient with informed advice about options? The physician should encourage surveillance when it is foreseeing When intervention is indicated, surgical repair is still the standard of care. When advising patients about the option of endovascular repair, long-term issues from ongoing clinical trials should provide the best guidance for the appropriate part of this intervention.

REFERENCES

(1) Anderson RN Deaths: leading causes for 2000 National Vital Statistics Report 2002;50:1-86 Accessed online March 2 2006 at: http://www.cdc.gov/nchs/data/ nvsr/nvsr50/nvsr50_16pdf

(2) exult P, Shaw E, Earnshaw JJ Poskitt KR Whyman MR Heather BP A single normal ultrasonographic scan at age 65 years dominions out significant aneurysm disease for life in men Br J Surg 2001;88:941-4