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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Ahmed R, Ghoorah K, Kunadian V. Abdominal Aortic Aneurysms and Risk Factors for Adverse Events. [Review]. Cardiol Rev. 24(2):88-93, 2016 Mar-Apr. Review/Other-Dx N/A To discuss risk factors for AAA rupture, which should be considered during the management process, to advance current deficiencies in management pathways. No results stated in abstract. 4
2. Lim J, Wolff J, Rodd CD, Cooper DG, Earnshaw JJ. Outcome in Men with a Screen-detected Abdominal Aortic Aneurysm Who are not Fit for Intervention. Eur J Vasc Endovasc Surg. 50(6):732-6, 2015 Dec. Review/Other-Tx 334 male patients To identify the reasons for initial nonintervention and subsequent outcomes from a combination of hospital case notes and general practitioner records. Of 334 men referred, 59 (median age 71 years, range 62-83 years) did not have intervention within 3 months (initial nonintervention rate 17.6%). The reasons included placed back on surveillance after assessment (n = 34); immediately discharged (n = 12); required further investigations (n = 5); died before complete assessment (n = 3); and incomplete follow-up (n = 5). Sixteen men had delayed AAA repair with no perioperative mortality. Overall mortality in the study was 14/34 (nine from ruptured AAA, the rest from medical conditions). Two further men survived repair of a ruptured AAA. The overall rate of ruptured AAA was 11/59 (18.6%). 4
3. Chun KC, Teng KY, Van Spyk EN, Carson JG, Lee ES. Outcomes of an abdominal aortic aneurysm screening program. J Vasc Surg. 57(2):376-81, 2013 Feb. Review/Other-Dx 9751 patients To identify persons at risk for the presence of an abdominal aortic aneurysm (AAA) through the evaluation of 5-year outcomes of an AAA screening program in a regional Veterans Affairs (VA) health care system. A total of 9751 patients (71.5 +/- 5.6 standard deviation years of age) were screened for an AAA over a 5-year period from January 1, 2007 to December 31, 2011. A total of 698 aneurysms (7.1%) were found. Referrals to a vascular surgeon were made on 45 patients with aneurysms >5.5 cm. Over a 5-year period, a total of 2754 patients (28.2%) were inappropriately screened: 416 patients were under 65 years old, 2243 patients were over 75 years old, 36 patients were women, and 123 patients without aneurysms had multiple screenings. In 2007, during the first year of implementation, 39.2% of patients were inappropriately screened. Over the next 4 years, inappropriate screenings decreased with 33.7% in 2008, 28.6% in 2009, 17.7% in 2010, and 14.3% in 2011. 4
4. Giardina S, Pane B, Spinella G, et al. An economic evaluation of an abdominal aortic aneurysm screening program in Italy. J Vasc Surg. 54(4):938-46, 2011 Oct. Review/Other-Dx two cohorts of 65- to 75-year-old men To assess the benefit of screening in Italy, we developed a cost-effective Markov model comparing screening vs non-screening scenarios. Considering an attendance rate of 62%, the individual cost per invited subject was €60 (US $83.2); 0.011 additional quality adjusted life years (QALY) were gained per patient in the screened cohort, corresponding to an incremental cost-effectiveness ratio (ICER) of €5673/QALY (US $7870/QALY). The results were sensitive to some parameter variations but consistent with the base case scenario. They suggest that on the basis of a willingness-to-pay threshold of €50,000/QALY, screening for AAA is cost-effective, with a probability approaching 100%. 4
5. Macdonald AJ, Faleh O, Welch G, Kettlewell S. Missed opportunities for the detection of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 35(6):698-700, 2008 Jun. Review/Other-Dx 104 patients To determine whether patients attending as emergencies with ruptured AAA could have been detected opportunistically prior to rupture. In this series 77% of patients were not previously known to have abdominal aortic aneurysms (AAA). Of these patients 76% had been reviewed in hospital during the preceding 5 years on a combined total of 355 occasions. 56% of patients had been seen in hospital during the year preceding rupture on a total of 80 occasions, only undergoing 17 abdominal examinations. 4
6. Schmidt T, Muhlberger N, Chemelli-Steingruber IE, et al. Benefit, risks and cost-effectiveness of screening for abdominal aortic aneurysm. [Review] [50 refs]. ROFO Fortschr Geb Rontgenstr Nuklearmed. 182(7):573-80, 2010 Jul. Review/Other-Dx N/A To summarize the current evidence from published health economic models for the long-term effectiveness and cost-effectiveness of screening programs for AAA 8 cost-effectiveness models published between 1993 and 2007 comparing AAA screening and lack of screening in men over 60. One model yielded a loss of life-years at additional costs. The remaining seven models yielded gains in life expectancy ranging from 0.02 to 0.28LYs. Gains in quality-adjusted life expectancy reported by six of the seven models ranged from 0.015 to 0.059 QALYs. Incremental costs ranged from 96 to 721 Euros. Incremental cost-effectiveness ratios (ICER) ranged from 1443 to 13 299 Euros per LY or QALY gained. CONCLUSION: Based on our analysis, the introduction of a screening program to identify AAA will probably gain additional life years and quality of life at acceptable extra costs. The target population for a screening program should be men 65 years and older. 4
7. Stather PW, Dattani N, Bown MJ, Earnshaw JJ, Lees TA. International variations in AAA screening. Eur J Vasc Endovasc Surg. 45(3):231-4, 2013 Mar. Review/Other-Dx N/A To assess the state and variability of AAA screening programmes worldwide. Six countries are in the process of implementing national AAA screening programmes, with Italy still performing screening trials. There is wide variability in inclusion criteria between countries with the majority screening only men in their 65th year, however 3 programmes include women, 2 programmes only include patients with high cardiovascular risk, and 2 trials are also screening for hypertension and lower limb atherosclerosis. Surveillance intervals vary between screening programmes, with the most common regimen being to vary the surveillance interval depending upon aneurysm size, however the optimum surveillance interval in terms of decreasing mortality and cost effectiveness remains uncertain. 4
8. Wild JB, Stather PW, Biancari F, et al. A multicentre observational study of the outcomes of screening detected sub-aneurysmal aortic dilatation. Eur J Vasc Endovasc Surg. 45(2):128-34, 2013 Feb. Review/Other-Dx 1696 patients To determine the outcomes of patients with screening detected sub aneurysmal aortic dilatation. Aortic measurements for 1696 men and women (median age 66 years at initial scan) with sub-aneurysmal aortae were obtained, median period of follow up was 4.0 years (range 0.1-19.0 years). Following Kaplan Meier and life table analysis 67.7% of patients with 5 complete years of surveillance reached an aortic diameter of 30 mm or greater however 0.9% had an aortic diameter of 54 mm. A total of 26.2% of patients with 10 complete years of follow up had an AAA of greater that 54 mm. 4
9. Al-Thani H, El-Menyar A, Shabana A, Tabeb A, Al-Sulaiti M, Almalki A. Incidental abdominal aneurysms: a retrospective study of 13,115 patients who underwent a computed tomography scan. Angiology. 65(5):388-95, 2014 May. Review/Other-Dx 13,115 patients To evaluate the frequency and outcomes of abdominal aortic aneurysm (AAA) in Qatar. Of the 13,115 patients screened, 61 (0.5%) patients had abdominal aneurysms. Most (82%) patients with AAA were male with mean age of 67 ± 12 years. The incidence of AAA substantially increased with age. Cardiovascular risk factors were prevalent among patients with AAA. The main location of AAA was infrarenal (67%), followed by thoracoabdominal (23%). The mean AAA diameter was 5.3 ± 2.5 cm. The rate of AAA rupture was 8% with a mortality rate of 60%; 80% of these were infrarenal, and 80% of them had a diameter of =5.5 cm. Overall mortality was 33%. 4
10. Dell'Atti L.. Incidence of abdominal aortic aneurysm during diagnostic ultrasound for urologic disease: our experience. Arch Ital Urol Androl. 84(4):230-3, 2012 Dec. Review/Other-Dx 140 patients To perform an observational study on 140 consecutive patients of age over 50 years (range 50-82), who presented to our clinic to perform a routine ultrasound examination of the urinary tract: we consecutively evaluated in these patients the possible detection of abdominal aortic aneurysm. Ultrasonography of the abdomen is the test of choice for the detection of the disease, it is an examination of low-cost and non-invasive. It has a high diagnostic sensitivity 80%, in our study (result slightly less than the range reported by the literature 82-99%) and a specificity of 100%. 4
11. Khashram M, Jones GT, Roake JA. Prevalence of abdominal aortic aneurysm (AAA) in a population undergoing computed tomography colonography in Canterbury, New Zealand. Eur J Vasc Endovasc Surg. 50(2):199-205, 2015 Aug. Review/Other-Dx 4,644 patients To determine the prevalence of abdominal aortic aneurysm (AAA) in a population undergoing a computed tomography colonography (CTC) for gastrointestinal symptoms. Included were 4,893 scans on 4,644 patients (1,933 men [41.6%], 2,711 women [58.4%]) with a median age of 69.3 years (range 17.0-97.0 years). There were 309 scans on 289 patients (75.4% men) who had either an aneurysm or a previous aortic graft with a median age of 79.6 years (range 57.0-96.0 years). Of these, 223 had a native AAA >/=30 mm. The prevalence of AAA rose with age from 1.3% in men aged 55-64 years, to 9.1% in 65-74 year olds, 16.8% in 75-84 year olds, and 22.0% in >/=85 year olds. The corresponding figures in women were 0.4%, 2%, 3.9%, and 6.2%, respectively. 4
12. Trompeter AJ, Paremain GP. Incidental abdominal aortic aneurysm on lumbosacral magnetic resonance imaging - a case series. Magn Reson Imaging. 28(3):455-7, 2010 Apr. Review/Other-Dx N/A To report a case series of four patients who had incidental Abdominal aortic aneurysm (AAA) detected on lumbosacral MRI. One patient required open repair with an aortic graft due to the size of the aneurysm, although his symptoms were attributable to his spinal disease. All patients still required management of their degenerative spinal disease after their vascular review. We can find no other case reports of AAA as an incidental finding on lumbosacral MRI. 4
13. Claridge R, Arnold S, Morrison N, van Rij AM. Measuring abdominal aortic diameters in routine abdominal computed tomography scans and implications for abdominal aortic aneurysm screening. J Vasc Surg. 65(6):1637-1642, 2017 06. Review/Other-Dx 3246 computed tomography (CT) scans To determine the prevalence and relevance of incidental abdominal aortic aneurysm (AAA) on routine abdominal computed tomography (CT) and to audit the performance of radiologists to identify and report AAA. A total of 3332 scans were performed, of which 86 scans were excluded, resulting in a total cohort of 3246. There were 187 incidental AAAs detected with a prevalence of 5.8%. The prevalence was 8.7% in men and 3.1% in women. Whereas the prevalence increased with age, a significant number were detected in those younger than 65 years, with a prevalence of 1.5%. Of the 187 AAAs, 122 (65%) were reported by radiologists: 100% reporting rate in AAAs =50 mm, 87% in AAAs =40 to 49 mm, and 52% in AAAs =30 to 39 mm. Of these, 15% were specifically recommended for referral to a vascular service. Of the incidentally detected AAAs, 72% were considered to be clinically relevant, which is an overall 4.1% prevalence of AAAs with an ability to benefit. In addition, all 3246 subjects avoided the need for further AAA screening. 4
14. Lo RC, Schermerhorn ML. Abdominal aortic aneurysms in women. [Review]. J Vasc Surg. 63(3):839-44, 2016 Mar. Review/Other-Tx N/A To summarize what is currently known about the effect of gender on AAA presentation, treatment, and outcomes, and review current controversies over screening recommendations and threshold for repair in women. No results stated in abstract. 4
15. Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. Journal of Vascular Surgery. 67(1):2-77.e2, 2018 01. Review/Other-Dx N/A To provide practice guidelines on the care of patients with an abdominal aortic aneurysm using the Grading of Recommendations Assessment, Development, and Evaluation system. Along with providing guidance regarding the management of patients throughout the continuum of care, we have revised a number of prior recommendations and addressed a number of new areas of significance. New guidelines are provided for the surveillance of patients with an AAA, including recommended surveillance imaging at 12-month intervals for patients with an AAA of 4.0 to 4.9 cm in diameter. We recommend endovascular repair as the preferred method of treatment for ruptured aneurysms. Incorporating knowledge gained through the Vascular Quality Initiative and other regional quality collaboratives, we suggest that the Vascular Quality Initiative mortality risk score be used for mutual decision-making with patients considering aneurysm repair. We also suggest that elective EVAR be limited to hospitals with a documented mortality and conversion rate to open surgical repair of 2% or less and that perform at least 10 EVAR cases each year. We also suggest that elective open aneurysm repair be limited to hospitals with a documented mortality of 5% or less and that perform at least 10 open aortic operations of any type each year. To encourage the development of effective systems of care that would lead to improved outcomes for those patients undergoing emergent repair, we suggest a door-to-intervention time of <90 minutes, based on a framework of 30-30-30 minutes, for the management of the patient with a ruptured aneurysm. We recommend treatment of type I and III endoleaks as well as of type II endoleaks with aneurysm expansion but recommend continued surveillance of type II endoleaks not associated with aneurysm expansion. Whereas antibiotic prophylaxis is recommended for patients with an aortic prosthesis before any dental procedure involving the manipulation of the gingival or periapical region of teeth or perforation of the oral mucosa, antibiotic prophylaxis is not recommended before respiratory tract procedures, gastrointestinal or genitourinary procedures, and dermatologic or musculoskeletal procedures unless the potential for infection exists or the patient is immunocompromised. Increased utilization of color duplex ultrasound is suggested for postoperative surveillance after EVAR in the absence of endoleak or aneurysm expansion. 4
16. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. [Review] [1308 refs]. Circulation. 113(11):e463-654, 2006 Mar 21. Review/Other-Dx N/A Practice Guidelines for the management of patients with peripheral arterial disease -lower extremity, renal, mesenteric, and abdominal aortic. No results stated in abstract. 4
17. Kitagawa A, Mastracci TM, von Allmen R, Powell JT. The role of diameter versus volume as the best prognostic measurement of abdominal aortic aneurysms. J Vasc Surg. 58(1):258-65, 2013 Jul. Review/Other-Dx N/A To discuss if it is time for volume to replace, or compliment, aneurysm diameter as predictive of rupture, which is the subject of the current debate. No results stated in abstract. 4
18. RESCAN Collaborators, Bown MJ, Sweeting MJ, Brown LC, Powell JT, Thompson SG. Surveillance intervals for small abdominal aortic aneurysms: a meta-analysis. JAMA. 309(8):806-13, 2013 Feb 27. Meta-analysis 18 studies: 15,471 patients To limit risk of aneurysm rupture or excessive growth by optimizing ultrasound surveillance intervals. AAA (abdominal aortic aneurysms) growth and rupture rates varied considerably across studies. For each 0.5-cm increase in AAA diameter, growth rates increased on average by 0.59 mm per year (95% CI, 0.51-0.66) and rupture rates increased by a factor of 1.91 (95% CI, 1.61-2.25). For example, to control the AAA growth risk in men of exceeding 5.5 cm to below 10%, on average, a 7.4-year surveillance interval (95% CI, 6.7-8.1) is sufficient for a 3.0-cm AAA, while an 8-month interval (95% CI, 7-10) is necessary for a 5.0-cm AAA. To control the risk of rupture in men to below 1%, the corresponding estimated surveillance intervals are 8.5 years (95% CI, 7.0-10.5) and 17 months (95% CI, 14-22). Good
19. Mell MW, Baker LC. Payer status, preoperative surveillance, and rupture of abdominal aortic aneurysms in the US Medicare population. Ann Vasc Surg. 28(6):1378-83, 2014 Aug. Review/Other-Dx 9,063 patients To determine the factors contributing to increased rate of ruptured abdominal aortic aneurysms (AAAs) for elderly poor patients. No differences in rupture were observed in women based on payer status. Medicaid-eligible men were more likely to present with ruptured AAA (odds ratio [OR] 2.42, 95% confidence interval [CI] 1.65-3.52). After adjusting for patient and hospital factors, the poor remained at higher risk for rupture (OR 1.5, 95% CI 1.10-2.26). This disparate risk of rupture was more commonly observed in hospitals treating a higher proportion of Medicaid-eligible patients. We estimate that 36% of the observed disparity in rupture for the elderly poor is explained by patient factors, 27% by gaps in surveillance, 9% by hospital factors, and <1% by socioeconomic factors. 4
20. Thompson AR, Cooper JA, Ashton HA, Hafez H. Growth rates of small abdominal aortic aneurysms correlate with clinical events. Br J Surg. 97(1):37-44, 2010 Jan. Review/Other-Dx Article ordered Rosenight - Ce 1649 patients To identify predictors of AAA-related events (surgery or death) with a view to better targeting of screening. Some 1231 subjects met the inclusion criteria of having more than one scan and a surveillance interval of over 3 months. AAA growth showed a bimodal pattern with nearly 50 per cent of all aneurysms never progressing to surgery or rupture. Adjusted annual AAA growth rates of at least 2 mm significantly predicted AAA-related events. 4
21. van Walraven C, Wong J, Morant K, et al. Radiographic monitoring of incidental abdominal aortic aneurysms: a retrospective population-based cohort study. Open Med. 5(2):e67-76, 2011. Review/Other-Dx 191 patients To measure the completeness of radiographic monitoring of incidental AAAs by means of a population-based analysis. For the period between January 1996 and September 2008, we identified 191 patients with incidental AAA (mean diameter 37.6 mm, 95% confidence interval [CI] 36.6-38.6 mm; median follow-up 4.4 [range 0.6-12.7] years). Fifty-six of these patients (29.3%) had no radiographic monitoring of the aneurysm. Overall, patients spent one-fifth of their time with incomplete monitoring of the AAA (median 19.4%, interquartile range 0.3%-44.0%). Factors independently associated with incomplete monitoring included older age (relative rate [change in proportion of time with incomplete monitoring] [RR] 1.27, 95% CI 1.10-1.47, per decade), larger size (RR 1.65, 95% CI 1.38-2.01, per 10-mm increase) and detection of the aneurysm while the patient was in hospital or the emergency department (RR 1.34, 95% CI 1.00-1.79). Comorbidities were not associated with monitoring. 4
22. Cao P, De Rango P, Verzini F, et al. Comparison of surveillance versus aortic endografting for small aneurysm repair (CAESAR): results from a randomised trial. Eur J Vasc Endovasc Surg 2011;41:13-25. Experimental-Dx 360 patients To compare results after endovascular aortic aneurysm repair (EVAR) or surveillance in AAA <5.5 cm. Between 2004 and 2008, 360 patients (early EVAR = 182; surveillance = 178) were enrolled. One perioperative death after EVAR and two late ruptures (both in the surveillance group) occurred. At 54 months, there was no significant difference in the main end-point rate [hazard ratio (HR) 0.76; 95% confidence interval (CI) 0.30-1.93; p = 0.6] with Kaplan-Meier estimates of all-cause mortality of 14.5% in the EVAR and 10.1% in the surveillance group. Aneurysm-related mortality, aneurysm rupture and major morbidity rates were similar. Kaplan-Meier estimates of aneurysms growth =5 mm at 36 months were 8.4% in the EVAR group and 67.5% in the surveillance group (HR 10.49; 95% CI 6.88-15.96; p < 0.01). For aneurysms under surveillance, the probability of delayed repair was 59.7% at 36 months (84.5% at 54 months). The probability of receiving open repair at 36 months for EVAR feasibility loss was 16.4%. 2
23. Ouriel K, Clair DG, Kent KC, Zarins CK, Positive Impact of Endovascular Options for treating Aneurysms Early (PIVOTAL) Investigators. Endovascular repair compared with surveillance for patients with small abdominal aortic aneurysms. J Vasc Surg. 51(5):1081-7, 2010 May. Experimental-Tx 728 total patients, 366 early endovascular repair, 362 US surveillance A randomized clinical trial to demonstrate benefit for early surgical repair of small aneurysms compared with surveillance. After a mean follow-up of 20 +/- 12 months (range, 0-41 months), 15 deaths had occurred in each group (4.1%). The unadjusted HR (95% CI) for mortality after early endovascular repair was 1.01 (0.49-2.07, P=.98). Aneurysm rupture or aneurysm-related death occurred in two patients in each group (0.6%). The unadjusted HR was 0.99 (0.14-7.06, P=.99) for early endovascular repair. Early treatment with endovascular repair and rigorous surveillance with selective aneurysm treatment as indicated both appear to be safe alternatives for patients with small AAAs, protecting the patient from rupture or aneurysm-related death for at least 3 years. 1
24. Francois CJ, Skulborstad EP, Majdalany BS, et al. ACR Appropriateness Criteria® Abdominal Aortic Aneurysm: Interventional Planning and Follow-Up. J Am Coll Radiol 2018;15:S2-S12. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for abdominal Aortic aneurysm: interventional planning and follow-up. No results stated in abstract. 4
25. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/body-cta.pdf. Review/Other-Dx N/A Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. No abstract available. 4
26. Hafez H, Druce PS, Ashton HA. Abdominal aortic aneurysm development in men following a "normal" aortic ultrasound scan. Eur J Vasc Endovasc Surg. 36(5):553-8, 2008 Nov. Review/Other-Dx 22,961 male patients To determine predictors related to abdominal aortic aneurysm (AAA) development following a "normal" aortic ultrasound scan. AAA prevalence was 4.4% at initial scanning. In those with a normal scan, 46 patients subsequently presented with AAAs incidentally detected and 120 (2.8%) had AAAs identified as part of the ongoing surveillance. The median initial aortic size of these 166 men was 25 mm (range 15-29 mm). Over the follow-up period, there have been 24 (14%) AAA-related deaths, 24 patients underwent successful AAA surgery and 36 died of unrelated causes. In those with an initial aortic diameter of <25 mm who later developed an AAA, the odds ratio for AAA-related mortality was 2 (95% CI 1-4.1, p=0.03, x(2)). 4
27. Keefer A, Hislop S, Singh MJ, Gillespie D, Illig KA. The influence of aneurysm size on anatomic suitability for endovascular repair. J Vasc Surg. 52(4):873-7, 2010 Oct. Observational-Dx 228 patients To determine whether smaller AAAs are more likely to be anatomically suitable for EVAR; that is, whether suitability is lost as the AAA grows. Of 3005 aortic US studies performed during this period, 221 had CT scans showing infrarenal aneurysms. Of these, 168 patients (76%) were candidates for EVAR and 52 (24%) were not, most commonly due to a short neck (40; 77% of excluded). Size measured by CT scanning (mean, 53 +/- 11 mm) averaged 4 mm larger than by US imaging (mean, 49 +/- 10 mm; r(2) = 0.66; P < .0001). Aneurysm size measured by CT scanning (P < .0001) or US imaging (P < .0001) correlated with anatomic suitability for EVAR. Mean sizes for those suitable were 52 +/- 9 mm by CT and 48 +/- 7 mm by US imaging, whereas mean sizes for those not suitable were 58 +/- 10 mm by CT and 53 +/- 8 mm by US imaging. Receiver operating characteristic curve analysis demonstrated that an US cutoff of 4.87 mm best predicted anatomic suitability (86.2% if smaller, 64.8% if larger), whereas a CT cutoff of 57.0 mm best predicted suitability (84.7% if smaller, 63.2% if larger). 4
28. Beales L, Wolstenhulme S, Evans JA, West R, Scott DJ. Reproducibility of ultrasound measurement of the abdominal aorta. [Review]. Br J Surg. 98(11):1517-25, 2011 Nov. Review/Other-Dx N/A To examine potential observer bias and variability in ultrasound measurements. Variation in intraobserver repeatability and interobserver reproducibility was identified. Six studies reported intraobserver repeatability coefficients for AP aortic diameter measurements of 1.6-4.4 mm. These were below the 5-mm level regarded as acceptable by the UK and USA AAA screening programmes. Five studies had interobserver reproducibility below the level of 5 mm. Four studies, however, reported poor reproducibility (range from -2 to +5.2 to -10.5 to +10.4); these differences may have had a significant clinical impact on screening and surveillance. 4
29. Gurtelschmid M, Bjorck M, Wanhainen A. Comparison of three ultrasound methods of measuring the diameter of the abdominal aorta. Br J Surg. 101(6):633-6, 2014 May. Experimental-Dx 127 consecutive patients To determine the variability of the three methods, differences between them, and the consequences on prevalence estimates. The variability was 2.7 (95 per cent limits of agreements +/- 5.4) mm for the OTO, 2.3 (+/- 4.6) mm for the ITI and 2.0 (+/- 4.0) mm for the LELE method. The corresponding coefficients of variability were 6.4, 6.1 and 5.0 per cent. The difference was 4.1 mm between ITI and OTO (P < 0.001), 2.0 mm between ITI and LELE (P < 0.001), and 2.1 mm between LELE and OTO (P < 0.001). 2
30. Kauffmann C, Tang A, Therasse E, et al. Measurements and detection of abdominal aortic aneurysm growth: Accuracy and reproducibility of a segmentation software. Eur J Radiol. 81(8):1688-94, 2012 Aug. Observational-Dx 28 consecutive patients To validate the reproducibility and accuracy of a software dedicated to measure abdominal aortic aneurysm (AAA) diameter, volume and growth over time. Mean D-max and volume were 49.6+/-6.2mm and 117.2+/-36.2ml for baseline and 53.6+/-7.9mm and 139.6+/-56.3ml for follow-up studies. Volume growth (17.3%) was higher than D-max progression (8.0%) between baseline and follow-up examinations (p<.0001). For the senior radiologist, intra-observer ICC of D-max and volume measurements were respectively estimated at 0.997 (>/=0.991) and 1.000 (>/=0.999). Overall inter-observer ICC of D-max and volume measurements were respectively estimated at 0.995 (0.990-0.997) and 0.999 (>0.999). Bland-Altman analysis showed excellent inter-reader agreement with a repeatability coefficient <3mm for D-max, <7% for relative D-max growth, <6ml for volume and <6% for relative volume growth. 2
31. Wanhainen A, Mani K, Golledge J. Surrogate Markers of Abdominal Aortic Aneurysm Progression. [Review]. Arterioscler Thromb Vasc Biol. 36(2):236-44, 2016 Feb. Review/Other-Dx N/A To review surrogate markers of AAA progression. No results stated in abstract. 4
32. Sweeting MJ, Thompson SG, Brown LC, Powell JT, RESCAN collaborators. Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms. [Review]. Br J Surg. 99(5):655-65, 2012 May. Meta-analysis 18 studies: 15,475 patients To analyze individual data collated from 15,475 people under follow-up for a small aneurysm in 18 studies. The mean aneurysm growth rate of 2.21 mm/year was independent of age and sex. Growth rate was increased in smokers (by 0.35 mm/year) and decreased in patients with diabetes (by 0.51 mm/year). Mean arterial pressure had no effect and antihypertensive or other cardioprotective medications had only small, non-significant effects on aneurysm growth, consistent with the observation that calendar year of enrollment was not associated with growth rate. Rupture rates were almost fourfold higher in women than men (P < 0.001), were double in current smokers (P = 0.001) and increased with higher blood pressure (P = 0.001). Good
33. Labruto F, Blomqvist L, Swedenborg J. Imaging the intraluminal thrombus of abdominal aortic aneurysms: techniques, findings, and clinical implications. [Review]. J Vasc Interv Radiol. 22(8):1069-75; quiz 1075, 2011 Aug. Review/Other-Dx N/A To describe the techniques, findings, clinical implications, advantages, and disadvantages of imaging the ILT by ultrasound, contrast-enhanced computed tomography, and magnetic resonance imaging. No results stated in abstract. 4
34. Martufi G, Forneris A, Appoo JJ, Di Martino ES. Is There a Role for Biomechanical Engineering in Helping to Elucidate the Risk Profile of the Thoracic Aorta?. [Review]. Ann Thorac Surg. 101(1):390-8, 2016 Jan. Review/Other-Dx N/A To identify open problems and highlight the future possibility of a multidisciplinary approach that includes biomechanics and imaging to evaluate the likelihood of rupture or dissection. No results stated in abstract. 4
35. American College of Radiology. Manual on Contrast Media. Available at: http://www.acr.org/Quality-Safety/Resources/Contrast-Manual. Review/Other-Dx N/A Guidance document on contrast media to assist radiologists in recognizing and managing risks associated with the use of contrast media. N/A 4
36. Goshima S, Kanematsu M, Kondo H, et al. Preoperative planning for endovascular aortic repair of abdominal aortic aneurysms: feasibility of nonenhanced MR angiography versus contrast-enhanced CT angiography. Radiology. 267(3):948-55, 2013 Jun. Observational-Dx 50 Patients To compare vascular measurements to determine stent types and configurations for abdominal endovascular aneurysm repair (EVAR) by comparing results of contrast material-enhanced computed tomographic (CT) angiography and nonenhanced magnetic resonance (MR) angiography. No significant difference was found in aortic neck diameter (observer 1: CT, 18.5 mm; MR, 19.0 mm; P = .43) (observer 2: CT, 19.6 mm; MR, 19.3 mm; P = .59), aortic neck diameter 15 mm distal to the lowest renal artery (observer 1: CT, 19.2 mm; MR, 19.2 mm; P = .38) (observer 2: CT, 19.6 mm; MR, 19.6 mm; P = .91), aortic neck length (observer 1: CT, 43.6 mm; MR, 43.6 mm; P = .85) (observer 2: CT, 44.4 mm; MR, 44.0 mm; P = .93), or other key vascular measurements (P = .23-.99) for preoperative planning. These included aneurysm diameter, lowest renal artery to aortic bifurcation length, aortic bifurcation diameter, common iliac artery diameters, external iliac artery diameters, length between orifices of lower renal and internal iliac arteries, and iliac artery sealing length. CT and MR angiography measurements showed very strong correlation (r = 0.92-0.99). Intraclass correlation coefficients between observers ranged from 0.90 to 0.98. Stent types and configurations determined with CT measurements remained unaltered when reassessed with MR measurements. 1
37. Ichihashi S, Marugami N, Tanaka T, et al. Preliminary experience with superparamagnetic iron oxide-enhanced dynamic magnetic resonance imaging and comparison with contrast-enhanced computed tomography in endoleak detection after endovascular aneurysm repair. J Vasc Surg. 58(1):66-72, 2013 Jul. Observational-Dx 23 patients To examine superparamagnetic iron oxide (SPIO)-enhanced dynamic MRI as a potential alternative to contrast-enhanced computed tomogrpahy (CE-CT) for detection of endoleaks after EVAR. A total of 11 type II endoleaks originating from either the lumbar or inferior mesenteric artery were detected. Eight were able to be detected by CE-CT (8/11:73%) and 10 (10/11:91%) by SPIO-enhanced MRI. Interobserver (kappa = 0.91; 95% CI, 0.74-1.00) and intraobserver agreement for MRI (kappa = 1.00) were excellent. Intermodality agreement for endoleak detection was moderate (kappa = 0.63; 95% CI, 0.32-0.94; and kappa = 0.62; 95% CI, 0.29-0.95 for observers A and B, respectively). 1
38. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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