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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Collard M, Sutphin PD, Kalva SP, et al. ACR Appropriateness Criteria® Abdominal Aortic Aneurysm Follow-up (Without Repair). J Am Coll Radiol 2019;16:S2-S6. 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 follow-up (without repair). No results stated in abstract. 4
2. 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
3. Conlisk N, Forsythe RO, Hollis L, et al. Exploring the Biological and Mechanical Properties of Abdominal Aortic Aneurysms Using USPIO MRI and Peak Tissue Stress: A Combined Clinical and Finite Element Study. J Cardiovasc Transl Res. 10(5-6):489-498, 2017 Dec. Observational-Dx 50 patients >40 years with AAA To explore the spatial relationship between areas of mural cellular inflammation measured by USPIO uptake on MRI and regions of high tissue stress determined through patient-specific FE modelling, for a group of 50 patients under surveillance for AAA disease. USPIO uptake was compared with wall stress predictions from CTA-based patient-specific FE models of each aneurysm. Elevated stress was commonly observed in areas vulnerable to rupture (e.g. posterior wall and shoulder). Only 16% of aneurysms exhibited co-localisation of elevated stress and mural USPIO enhancement. Globally, no correlation was observed between stress and other measures of USPIO uptake (i.e. mean or peak). 3
4. Obel LM, Diederichsen AC, Steffensen FH, et al. Population-Based Risk Factors for Ascending, Arch, Descending, and Abdominal Aortic Dilations for 60-74-Year-Old Individuals. J Am Coll Cardiol. 78(3):201-211, 2021 07 20. Experimental-Dx 14,989 participants aged 60-74 years (14,235 men, 754 women) To determine the most dominant predictors for dilations at the ascending, arch, descending, and abdominal part of the aorta, and to establish comprehensive risk factor profiles for each aortic segment. The study population consisted of 14,989 participants (14,235 men, 754 women) with an average age of 68 ± 4 years. The highest adjusted odd ratios for having any aortic dilation were observed when coexisting aortic dilations were present. Other noteworthy predictors included coexisting iliac dilations, hypertension, increasing body surface area, male sex, familial disposition, and atrial fibrillation, which were present in various combinations for the different aortic parts. Smoking and acute myocardial infarction were inversely associated with ascending and abdominal dilations. Diabetes was a shared protective factor. 3
5. Tillman K, Lee OD, Whitty K. Abdominal aortic aneurysm: an often asymptomatic and fatal men's health issue. Am j. men's health. 7(2):163-8, 2013 Mar. Review/Other-Dx N/A To present a comprehensive overview of AAA disease and summarizes current evidence-based diagnostic and treatment guidelines, the importance of educating men about this health issue, and the need for more widespread AAA ultrasound screening opportunities. No results in abstract. 4
6. 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
7. Moll FL, Powell JT, Fraedrich G, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg 2011;41 Suppl 1:S1-S58. Review/Other-Dx N/A To provide clinical practice guidance for surgeons and physicians involved in the care of patients with abdominal aortic aneurysms (AAAs). No abstract available 4
8. Guirguis-Blake JM, Beil TL, Senger CA, Coppola EL. Primary Care Screening for Abdominal Aortic Aneurysm: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 322(22):2219-2238, 2019 12 10. Meta-analysis Fifty studies (N = 323,279) To systematically review the evidence on benefits and harms of AAA screening and small aneurysm treatment to inform the US Preventive Services Task Force. Fifty studies (N = 323 279) met inclusion criteria. Meta-analysis of population-based randomized clinical trials (RCTs) estimated that a screening invitation to men 65 years or older was associated with a reduction in AAA-related mortality over 12 to 15 years (OR, 0.65 [95% CI, 0.57-0.74]; 4 RCTs [n = 124 926]), AAA-related ruptures over 12 to 15 years (OR, 0.62 [95% CI, 0.55-0.70]; 4 RCTs [n = 124 929]), and emergency surgical procedures over 4 to 15 years (OR, 0.57 [95% CI, 0.48-0.68]; 5 RCTS [n = 175 085]). In contrast, no significant association with all-cause mortality benefit was seen at 12- to 15-year follow-up (relative risk, 0.99 [95% CI 0.98-1.00]; 4 RCTs [n = 124 929]). One-time screening was associated with significantly more procedures over 4 to 15 years in the invited group compared with the control group (OR, 1.44 [95% CI, 1.34-1.55]; 5 RCTs [n = 175 085]). Four trials (n = 3314) of small aneurysm surgical treatment demonstrated no significant difference in AAA-related mortality or all-cause mortality compared with surveillance over 1.7 to 12 years. These 4 early surgery trials showed a substantial increase in procedures in the early surgery group. For small aneurysm treatment, registry data (3 studies [n = 14 424]) showed that women had higher surgical complications and postoperative mortality compared with men. Good
9. Guirguis-Blake JM, Beil TL, Senger CA, Whitlock EP. Ultrasonography screening for abdominal aortic aneurysms: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2014;160:321-9. Review/Other-Dx N/A To systematically review evidence about the benefits and harms of ultrasonography screening for AAAs in asymptomatic primary care patients. Reviews of 4 RCTs involving 137,214 participants demonstrated that 1-time invitation for AAA screening in men aged 65 years or older reduced AAA rupture and AAA-related mortality rates for up to 10 and 15 years, respectively, but had no statistically significant effect on all-cause mortality rates up to 15 years. Screening was associated with more overall and elective surgeries but fewer emergency operations and lower 30-day operative mortality rates at up to 10- to 15-year follow-up. One RCT involving 9342 women showed that screening had no benefit on AAA-related or all-cause mortality rates. 4
10. Schermerhorn M. A 66-year-old man with an abdominal aortic aneurysm: review of screening and treatment. JAMA 2009;302:2015-22. Review/Other-Dx 1 case To report a case, a 66-year-old man with a 5.2-cm AAA, illustrating the issues surrounding monitoring and treating AAA. No results in abstract. 4
11. Norman PE, Jamrozik K, Lawrence-Brown MM, et al. Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm. BMJ 2004;329:1259. Experimental-Dx 19,352 patients (intervention group) and 19,352 patients (control group) To assess whether screening for abdominal aortic aneurysms in men reduces mortality. The corrected response to invitation to screening was 70%. The crude prevalence was 7.2% for aortic diameter > or = 30 mm and 0.5% for diameter > or = 55 mm. Twice as many men in the intervention group than in the control group underwent elective surgery for abdominal aortic aneurysm (107 v 54, P = 0.002, chi2 test). Between scheduled screening and the end of follow up 18 men in the intervention group and 25 in the control group died from abdominal aortic aneurysm, yielding a mortality ratio of 0.61 (95% confidence interval 0.33 to 1.11). Any benefit was almost entirely in men aged between 65 and 75 years, where the ratio was reduced to 0.19 (0.04 to 0.89). 3
12. Howell CM, Rabener MJ. Abdominal aortic aneurysm: A ticking time bomb. JAAPA. 29(3):32-6, 2016 Mar. Review/Other-Dx N/A To explore the pathogenesis, presentation, diagnosis, treatment, and prevention of AAA. No results in abstract. 4
13. Liisberg M, Diederichsen AC, Lindholt JS. Abdominal ultrasound-scanning versus non-contrast computed tomography as screening method for abdominal aortic aneurysm - a validation study from the randomized DANCAVAS study. BMC med. imaging. 17(1):14, 2017 02 14. Experimental-Dx 533 patients To validate non-contrast-enhanced computed tomography (nCT) compared to ultrasound sonography (US) as a screening method for abdominal aortic aneurysm (AAA) screening. Due to logistics, 533 underwent both nCT and US. In four patients, aortae could not be visualized with US, and two of these had an AAA (>30 mm) as diagnosed by nCT. Using nCT 30 (5.7%, 95% CI: 4.2;7.5%) AAA were found. US failed to detect 9 of these, but diagnosed 3 other cases, resulting prevalence by US was 4.5% (95% CI: 3.0;6.6%). Additionally, 5 isolated iliac aneurysms (=20 mm) (0.9%, 95% CI: 0.3;2.2%) were discovered by nCT. US performed reasonably, with sensitivity ranging from 57.1–70.4%, specificity however, ranged higher 99.2–99.6%. Comparably nCT performed with sensitivity ranging from 82.6–88.9%, nCTs specificity however ranged from 97.7–98. 4%. Analysis showed good correlations with no tendency to increasing variance with increasing diameter, and no significant differences between nCT and US with means varying slightly in both axis. 2
14. 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
15. Gordon JR, Wahls T, Carlos RC, Pipinos, II, Rosenthal GE, Cram P. Failure to recognize newly identified aortic dilations in a health care system with an advanced electronic medical record. Ann Intern Med 2009;151:21-7, W5. Observational-Dx 4,112 patients with new dilations of the abdominal aorta detected on CT performed To examine the frequency with which computed tomography (CT)-documented dilations of the abdominal aorta are accompanied by evidence in the electronic medical record (EMR) that a clinician recognized the abnormality. Computed tomography scans of 4112 patients were reviewed and 440 (11%) aortic dilations were identified, of which 91 were new findings. Radiologists directly notified clinical teams about 5 (5%) new dilations. Clinical teams did not record in the EMR recognition of 53 of 91 (58%) dilations within 3 months of the CT, and 9% of these dilations were 5.5 cm or larger. The median time to recognition of aneurysm in the EMR was 237 days, and no EMR documentation existed for 16 abnormalities (29% of surviving patients) during a mean follow-up of 3.2 years. No evidence indicated that any of the aneurysms ruptured or that patient deaths resulted from the delayed follow-up. 4
16. Borgbjerg J, Christensen HS, Al-Mashhadi R, et al. Ultra-low-dose non-contrast CT and CT angiography can be used interchangeably for assessing maximal abdominal aortic diameter. Acta Radiol Open 2022;11:20584601221132461. Observational-Dx 50 patients who underwent CTA and a normal-dose non-contrast CT for suspected renal artery stenosis To determine whether ultra-low-dose non-contrast CT (ULDNC-CT) can be used instead of the gold standard CT angiography (CTA) for assessment of maximal abdominal aortic diameter. Observers completed 1400 measurements encompassing repeated CTA and ULDNC-CT measurements. The mean diameter was 24.0 and 25.0 mm for CTA and ULDNC-CT, respectively, yielding a significant but minor mean difference of 1.0 mm. The 95% LOAM reproducibility was similar for CTA and ULDNC-CT (2.3 vs 2.3 mm). In addition, the 95% LOAM and mean diameters were similar for CTA and ULDNC-CT when observers were grouped as consultants and residents. 2
17. Tomee SM, Meijer CA, Kies DA, et al. Systematic approach towards reliable estimation of abdominal aortic aneurysm size by ultrasound imaging and CT. [Review]. BJS open. 5(1), 2021 01 08. Review/Other-Dx 9 studies To devise a uniform ultrasound acquisition and measurement protocol, and to test whether harmonization of ultrasound and CT readings is feasible. Based on a literature review, an ultrasound acquisition and reading protocol was devised. Evaluation of the protocol showed an intraobserver repeatability of 1.6 mm (2s.d.) and an interobserver intraclass correlation coefficient (ICC) of 0.97. Comparison of protocolled ultrasound readings and local CT readings indicated a good correlation (r = 0.81), but a systematic +4.1-mm difference for CT. Harmonized size readings for ultrasound imaging and CT increased the correlation (r = 0.91) and reduced the systematic difference to +1.8 mm by CT. Interobserver reproducibility of protocolized CT measurements showed an ICC of 0.94 for the inner-to-inner method and 0.96 for the outer-to-outer method. 4
18. 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
19. Cieri E, Simonte G, Costarelli D, et al. Computed Tomography Postprocessing for Abdominal Aortic Aneurysm Lumen Recognition in Unenhanced Examinations. Ann Vasc Surg. 60:407-414, 2019 Oct. Observational-Dx 5 patients (233 CT images) To introduce a tool for the diagnosis of abdominal aortic aneurysms (AAAs) by avoiding the use of contrast medium (CM). The algorithm was applied to 233 CT images. Extracted images were compared with the ones with CM. Mean values of the numerical errors ranged from 0.12 to 0.17 for En and 0.11 to 0.35 for ?A. For all the 233 CT images in the analyzed sequences, the mean error was 0.14 (En) and 0.28 (?A). 3
20. Kolipaka A, Illapani VS, Kenyhercz W, et al. Quantification of abdominal aortic aneurysm stiffness using magnetic resonance elastography and its comparison to aneurysm diameter. J Vasc Surg. 64(4):966-74, 2016 Oct. Experimental-Dx 36 patients (1) determine magnetic resonance elastography (MRE)-derived aortic wall stiffness in AAA patients and its correlation to AAA diameter; (2) determine the correlation between AAA stiffness and amount of thrombus and calcium; and (3) compare the AAA stiffness measurements against age-matched healthy individuals. No significant correlation (P > .1) was found between AAA stiffness and diameter or amount of thrombus or calcium score. AAA stiffness (mean 13.97 ± 4.2 kPa) is significantly (P = .02) higher than remote normal aorta in AAA (mean 8.87 ± 2.2 kPa) patients and in normal individuals (mean 7.1 ± 1.9 kPa). 1
21. 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
22. Zhu C, Cao L, Wen Z, et al. Surveillance of abdominal aortic aneurysm using accelerated 3D non-contrast black-blood cardiovascular magnetic resonance with compressed sensing (CS-DANTE-SPACE). J Cardiovasc Magn Reson. 21(1):66, 2019 10 28. Observational-Dx 38 AAA patients To develop an accelerated sequence applying compressed sensing (CS-DANTE-SPACE) and validate it in AAA patients undergoing surveillance. CS-DANTE-SPACE achieved comparable image quality compared with DANTE-SPACE (3.15 ± 0.67 vs. 3.03 ± 0.64, p = 0.06). There was excellent agreement between results from the two sequences for diameter/area and ILT ratio measurements (ICCs> 0.85), and for quantifying growth rate (3.3 ± 3.1 vs. 3.3 ± 3.4 mm/year, ICC = 0.95.) CS-DANTE-SPACE showed a higher ILT-to-lumen contrast ratio (p = 0.01) and higher sharpness than DANTE-SPACE (p = 0.002). Both sequences had excellent inter-reader reproducibility for quantitative measurements (ICC > 0.88). 2
23. Ali MU, Fitzpatrick-Lewis D, Miller J, et al. Screening for abdominal aortic aneurysm in asymptomatic adults. [Review]. J Vasc Surg. 64(6):1855-1868, 2016 Dec. Meta-analysis 9 studies To examine the evidence on benefits and harms of AAA screening with ultrasound scan. For benefits of one-time AAA screening in men compared with controls, pooled analyses from four randomized controlled trials with moderate quality evidence showed significant reductions in AAA-related mortality and AAA rupture rate up to 13 to 15 years of follow-up with 42% reduction (risk ratio [RR], 0.58; 95% confidence interval [CI], 0.39-0.88; number needed to screen = 212) and 38% reduction (RR, 0.62; 95% CI, 0.45-0.86; number needed to screen = 200), respectively. The effect of on all-cause mortality was marginally significant for longer follow-up. The Chichester trial examined the benefits of one-time AAA screening in women and found no significant differences between screening and control arms for up to 10 years of follow-up (RR, 0.88; 95% CI, 0.72-1.07). For consequences of one-time AAA screening in men compared with controls, there was a significant increase in the total number of AAA-related procedures over a follow-up of 13 to 15 years (2.16 times more likely) compared with controls. For harms of one-time AAA screening, no significant differences were observed in 30-day postoperative mortality for elective and emergency operations with compared control groups. Evidence from the Multicenter Aneurysm Screening Study trial using 13-year follow-up data showed that one-time AAA screening with ultrasound scan was potentially associated with an overdiagnosis of 45% (95% CI, 42%-47%) among screen-detected men. Good
24. Duncan A, Maslen C, Gibson C, et al. Ultrasound screening for abdominal aortic aneurysm in high-risk women. British Journal of Surgery. 108(10):1192-1198, 2021 10 23. Observational-Dx 5,200 women aged 65-74 years deemed at high risk of having an AAA (current smokers, ex-smokers, or with a history of coronary artery disease) To determine the uptake of screening and prevalence of AAA in a group of women deemed at high risk of having an AAA using data that were readily available in UK primary care records (white European ethnicity, current/ex-smokers and/or past history of coronary artery disease). Some 6037 women were invited and 5200 attended screening (86.7 per cent). Fifteen AAAs larger than 29 mm were detected (prevalence 0.29 (95 per cent c.i. 0.18 to 0.48) per cent). Current smokers had the highest prevalence (0.83 (95 per cent c.i. 0.34 to 1.89) per cent) but lowest attendance (75.2 per cent). Three AAAs greater than 5.5 cm were identified and referred for consideration of surgical repair; one woman underwent repair. There was a significant reduction in patient-reported QoL scores following screening. 3
25. Svensjo S, Bjorck M, Wanhainen A. Editor's choice: five-year outcomes in men screened for abdominal aortic aneurysm at 65 years of age: a population-based cohort study. Eur J Vasc Endovasc Surg. 47(1):37-44, 2014 Jan. Observational-Dx 3,268 65-year-old male patients To determine the fate of a 65-year-old male population 5 years following an invitation to an aortic ultrasound (US) examination. In 2006-2007, 3,268 65-year-old men were invited, and 2,736 (83.7%) were examined. After 5 years, 24 had completed AAA repair (6 died within 0-4 years), an additional 239 had died, and 194 had moved. Thus, 2,811 70-year-old men were re-invited, and 2,247 (79.9%) were examined. The AAA prevalence increased from 1.5% at 65 to 2.4% (95% CI: 1.8 to 3.0) at 70, and of sub-aneurysmal aortas from 1.7% at 65 to 2.6% (2.0 to 3.3), at 70. Of 2,041 with <25 mm at 65, 0.7% had an AAA at 70. Of 40 with a sub-aneurysmal aorta at 65, 52.5% progressed to AAA at 70. In a Cox regression analysis, sub-aneurysmal aorta at 65 (hazard ratio [HR] 59.78) and smoking (HR 2.78) were independent risk factors for AAA formation. Among 44 with AAA at 65, 22 completed AAA repair with no 30-day mortality. 3
26. Isselbacher EM, Preventza O, Hamilton Black Iii J, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022;80:e223-e393. Review/Other-Dx N/A The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. 4
27. LeFevre ML, U.S. Preventive Services Task Force. Screening for abdominal aortic aneurysm: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 161(4):281-90, 2014 Aug 19. Review/Other-Dx N/A To provide a recommendation for to asymptomatic adults aged 50 years or older on screening for abdominal aortic aneurysm (AAA). 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 in men aged 65 to 75 years who have never smoked. (C recommendation). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA in women aged 65 to 75 years who have ever smoked. (I statement). The USPSTF recommends against routine screening for AAA in women who have never smoked. (D recommendation). 4
28. Owens DK, Davidson KW, Krist AH, et al. Screening for Abdominal Aortic Aneurysm: US Preventive Services Task Force Recommendation Statement. JAMA. 322(22):2211-2218, 2019 12 10. Review/Other-Dx N/A 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. No results stated in abstract. 4
29. Ruff AL, Teng K, Hu B, Rothberg MB. Screening for abdominal aortic aneurysms in outpatient primary care clinics. Am J Med. 128(3):283-8, 2015 Mar. Observational-Dx 15,120 patients in 2007 and 22,355 patients in 2012 To evaluate rates of screening performed intentionally with ultrasound and incidentally with other abdominal imaging, determine rates of redundant screening, and evaluate patient and physician characteristics associated with screening. There were 15,120 patients eligible for screening in 2007, and 22,355 in 2012. Screening with ultrasounds increased from 3.6% in 2007 to 9.2% in 2012. Screening with any imaging that included the aorta increased from 31% in 2007 to 41% in 2012. Of 2595 screening ultrasounds performed in either cohort, 800 (31%) were performed on patients who had already undergone another imaging modality. Of 153 physicians who had >50 eligible patients, rates of abdominal aortic aneurysm screening ranged from 7.5% to 79% (median 39%, interquartile range 31%-47%), and rates of ultrasound screening ranged from 0% to 47% (median 6.3%, interquartile range 3.6%-11.4%). Physician characteristics positively associated with screened patients included female sex (odds ratio [OR] 1.32; 95% confidence interval [CI], 1.12-1.54), specialty (Internal Medicine vs Family Medicine: OR 1.32; 95% CI, 1.14-1.54), and location (academic medical center vs family health center: OR 1.30; 95% CI, 1.04-1.62). 4
30. Hartshorne TC, McCollum CN, Earnshaw JJ, Morris J, Nasim A. Ultrasound measurement of aortic diameter in a national screening programme. Eur J Vasc Endovasc Surg 2011;42:195-9. Observational-Dx 60 random images of aorta To investigate the reliability and reproducibility of inner to inner (ITI) versus outer to outer (OTO) ultrasound measurement of AAA diameter. The mean (range) diameter for all 60 aortas by ITI was 3.91 cm (1.39-6.80) and by OTO was 4.18 cm (1.63-7.09), a significant mean difference of 0.27 cm (95% CI: 0.23-0.32 cm). The reproducibility coefficients for differences between technicians were 0.30 cm (95% CI: 0.24-0.36) for ITI and 0.42 cm (95% CI: 0.35-0.49) for OTO indicating significantly better repeatability using ITI. Finally, 15 images were measured twice in random order by all screeners and sonographers. For AAAs > 5 cm, repeatability was significantly better with ITI than OTO (0.14 vs. 0.21; p = 0.016). 3
31. Watson JDB, Gifford SM, Bandyk DF. Aortic aneurysm screening using duplex ultrasound: Choosing wisely who to examine. [Review]. Semin Vasc Surg. 33(3-4):54-59, 2020 Dec. Review/Other-Dx N/A To discuss screening of aortic aneurysm using duplex ultrasound. No results in abstract. 4
32. 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
33. Bihari P, Shelke A, Nwe TH, et al. Strain measurement of abdominal aortic aneurysm with real-time 3D ultrasound speckle tracking. Eur J Vasc Endovasc Surg. 45(4):315-23, 2013 Apr. Review/Other-Dx 5 patients To establish real-time 3-dimensional (3D) speckle tracking ultrasound to explore local displacement and strain parameters of the whole abdominal aortic aneurysm. Displacement parameters measured in vitro by 3D ultrasound and laser scan micrometer or video analysis were significantly correlated at pulse pressures between 40 and 80 mmHg. Strong local differences in displacement and strain were identified within the aortic aneurysms of patients. 4
34. Taniguchi R, Hoshina K, Hosaka A, et al. Strain analysis of wall motion in abdominal aortic aneurysms. Ann Vasc Dis 2014;7:393-8. Observational-Dx 19 abdominal aortic aneurysm (AAA) patients and 10 healthy volunteers To evaluate aortic wall motion with ultrasound speckle-tracking methods, originally used for analyzing cardiac wall motion. In the aneurysm and control groups, the mean values of peak strain along the 6 segments were 1.5% ± 0.6% vs. 4.7% ± 1.6% (p <0.0001), respectively. The coefficient of variation of the peak strain rate was higher in the AAA group (0.74 ± 0.20) than in the control group (0.56 ± 0.12; p <0.05). 3
35. 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
36. Cho IJ, Lee J, Park J, et al. Feasibility and accuracy of a novel automated three-dimensional ultrasonographic analysis system for abdominal aortic aneurysm: comparison with two-dimensional ultrasonography and computed tomography. Cardiovasc. ultrasound. 18(1):24, 2020 Jul 01. Observational-Dx 59 consecutive patients who had been diagnosed with AAA and 18 controls To evaluate the accuracy of a novel semi-automated 3-D ultrasonography (3-D US) system compared with that of CT as a reference. The Dmax values from 3-D US demonstrated better agreement (R2 = 0.984) with the CT values than with the 2-D US values (R2 = 0.938). Overall, 2-D US underestimated Dmax compared with 3-D US (32.3 ± 12.1 mm vs. 35.1 ± 12.0 mm). The Bland-Altman analysis of the 3-D US values, revealed better agreement with the CT values (2 standard deviations [SD], 2.9 mm) than with the 2-D US values (2 SD, 5.4 mm). The vessel, lumen, and thrombus areas all demonstrated better agreement with CT than with 2-D US (R2 = 0.986 vs. 0.960 for the vessel, R2 = 0.891 vs. 0.837 for the lumen, and R2 = 0.977 vs. 0.872 for the thrombus). The thrombus volume assessed with 3-D US showed good correlation with the CT value (R2 = 0.981 and 2 SD in the Bland-Altman analysis: 13.6 cm3). 3
37. Derwich W, Wittek A, Pfister K, et al. High Resolution Strain Analysis Comparing Aorta and Abdominal Aortic Aneurysm with Real Time Three Dimensional Speckle Tracking Ultrasound. Eur J Vasc Endovasc Surg. 51(2):187-93, 2016 Feb. Observational-Dx patients w/ normal aortic diameter and <60 years of age (n=21); normal aortic diameter and >60 years of age (n=25); infrarenal aortic aneurysm (n=19) To evaluate the applicability of 4D-US strain imaging to analyze biomechanical properties of the aorta. The analysis of biomechanical properties displayed increasing heterogeneous and dyssynchronous circumferential strain with increasing patient age. Young patients exhibited higher mean strain amplitude. The distribution of the spatial heterogeneity index and local strain ratio was inversely proportional to age. The maximum local strain amplitude was significantly higher in the young (0.26 ± 0.17) compared with the old (0.16 ± 0.07) or aneurysmal aorta (0.16 ± 0.10). Temporal dyssynchrony significantly differed between young (0.13 ± 0.10) and old (aneurysmal 0.31 ± 0.04, non-aneurysmal 0.29 ± 0.05), regardless of aortic diameter. The spatial heterogeneity index and local strain ratio differentiate non-aneurysmal and aneurysmal aorta, regardless of age. 3
38. Ghulam QM, Kilaru S, Ou SS, Sillesen H. Clinical validation of three-dimensional ultrasound for abdominal aortic aneurysm. J Vasc Surg. 71(1):180-188, 2020 01. Observational-Dx 106 patients To evaluate the interoperator reproducibility of maximum anterior-to-posterior diameter by nonphysician ultrasound technicians in a typical vascular laboratory setting, on patients with infrarenal AAAs using 3D-US and 2D-US examination. Excellent interoperator reproducibility was observed for measuring maximum diameter using 3D-US (intraclass correlation coefficient, 0.97), and good agreement among ultrasound technicians (mean difference, -0.08 mm; limits of agreement, -3.17; 3.00 mm). When using 3D-US examination, 74 of the 90 patients (82%) were estimated within 2 mm of interoperator variability. Of 90 patients, 52 (58%) were estimated to be within the same variability by 2D-US examination. Estimating AAA diameter using 3D-US was superior to 2D-US with respect to interoperator reproducibility. 3
39. Lowe C, Ghulam Q, Bredahl K, et al. Three-dimensional Ultrasound in the Management of Abdominal Aortic Aneurysms: A Topical Review. [Review]. Eur J Vasc Endovasc Surg. 52(4):466-474, 2016 Oct. Review/Other-Dx N/A To introduce clinicians to the current concepts of 3D ultrasound, review the current literature, and highlight avenues for further research in this new and exciting field of vascular imaging. No results provided 4
40. 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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