As a cardiac anesthesiologist, I’ve been involved in my fair share of open and endovascular abdominal aortic aneurysm (AAA) repairs. Although sometimes these are more emergent, contained ruptures, the majority of AAA repairs are electively performed for a progressive enlargement of an aneurysm. The magic number to intervene is usually > 5.5 cm in diameter.
The latest guidelines outlined by the United States Preventive Services Task Force (USPSTF) do not differ significantly from previous recommendations. These include performing a single screening abdominal ultrasound in men between 65 – 75 years old who have ever smoked (grade B recommendation, AAA prevalence ~ 7% in this group) and selectively in men within the same age range who have never smoked (grade C recommendation, AAA prevalence ~ 2% in this group). Women with no smoking or family history should not be screened (grade D recommendation, AAA prevalence 0.03 – 0.60%). For known AAA between 4 – 5 cm, repeat ultrasound every 6 months. Typical enlargement is by 0.1 – 0.2 cm/year, but if more than 0.5 cm within 6 months, REPAIR! Smaller AAA (3 – 4 cm) can be screened yearly.
Over the years, endovascular (aortic) aneurysm repairs (EVARs) have become increasingly popular and offer a less invasive, durable option for patients who are otherwise poor “open surgery” candidates; however, repeated interventions to address endoleaks or graft patency increase the rates of postop mortality.
Article: Freischlag JA. Updated Guidelines on Screening for Abdominal Aortic Aneurysms. JAMA. 2019;322(22):2177–2178. doi:https://doi.org/10.1001/jama.2019.19626