An abdominal aortic aneurysm (AAA) often strikes with no warning. Many patients don’t have symptoms until the aneurysm is about to burst. And a ruptured aorta kills more than 50% of patients, even if they make it to the hospital. AAA is the 15th most common cause of death in the U.S.
"Our team is happy to follow patients with early-stage AAA and report back to their primary doctor regularly.” — Paul Impellizzeri, MD
“Screening lets us get ahead of the disease and repair an AAA before it becomes deadly,” says Paul Impellizzeri, MD, FACS, FSVS, a vascular surgeon at WellSpan Health.
Who should be screened
The U.S. Preventive Services Task Force currently recommends screening for men ages 65 to 75 who have any history of smoking or currently smoke. Studies have found that about 7% of men in this cohort develop AAA and about 1% of their female counterparts.
That’s why Dr. Impellizzeri also suggests PCPs consider screening for female patients ages 65 to 75 who are current or former smokers or have other risk factors such as:
- A parent or sibling with AAA
- High cholesterol
- Hypertension
“There is room for improvement to get more patients screened who are candidates for it, so we can catch more cases of AAA and prevent death. Too many are dying from AAA, including women,” says Dr. Impellizzeri, who helps PCPs identify patients who may benefit from screening.
Consider for screening
- Men ages 65-75 with smoking history
- Women ages 65-75 with AAA risk factors
Simple screening, fast results
A quick abdominal ultrasound catches almost all AAA (94%-100%) and rarely gives a false positive result (less than 2%).
“Taking time out of the day for the test can be a hassle,” Dr. Impellizzeri says. “But it’s a very small investment on the patient’s part for a tremendous yield if indeed they have AAA.”
AAA defined
An abdominal aorta that is at least 1.5 times its normal diameter.
Usually this means the aorta has a diameter of 3 cm or more, but that can vary by patient.
WellSpan Health offers screening at multiple locations and Dr. Impellizzeri usually sends a note to the referring provider the same day. Patients who don’t have AAA don’t need additional screening tests; the ultrasound is one-and-done.
Guidelines to care for patients with AAA
Patients with an aneurysm of 5-5.5 centimeters or more in diameter typically need repair, either an open surgery or endovascular procedures to insert a covered stent.
Patients with a smaller aneurysm need ongoing monitoring and follow-up ultrasounds to determine if repair surgery is appropriate. They may also be candidates for surgery if:
- It’s growing rapidly (0.5 centimeters or more a year)
- It’s saccular shaped (bulging in one spot) rather than fusiform shaped (uniformly enlarged)
- They have embolic complications resulting in lower extremity ischemia
PCPs have the option of referring patients to a vascular surgeon for ongoing monitoring. A surgeon can follow them to determine how frequently they need ultrasounds based on the size and other features of the aneurysm.
“Some surgeons don’t want to see patients until they need a procedure. But our team is happy to follow patients with early-stage AAA and report back to their primary doctor regularly,” Dr. Impellizzeri says.
He adds that PCPs caring for AAA patients may notice some disease signs that seem unusual. Although AAA may cause a strong pulse near the belly button, it can be hard to detect in patients depending on their body size and shape. That’s why it’s important not to rely solely on physical exam and also obtain a screening ultrasound, Dr. Impellizzeri notes.
In addition, physicians may detect an unusually prominent pulse behind the knee that seems alarming. This may represent a popliteal artery aneurysm. Many of these patients will require monitoring and some may need surgery if the aneurysm grows large enough or if they present with symptoms of limb ischemia, Dr. Impellizzeri says.
Bringing screening benefits to more patients
Dr. Impellizzeri and his colleagues will soon launch a tool they developed to improve AAA screening and care — and bring more patients lifesaving treatment. The tool searches electronic health records of patients in the WellSpan Health system and alerts PCPs of individuals who meet the screening criteria or who have AAA and are overdue for a follow-up ultrasound.
“We know AAA screening criteria are broad and primary doctors are busy. They are not necessarily thinking, ‘This is a smoker and he’s over 65, so he should get screening,’” Dr. Impellizzeri says. “This tool can give them a helpful reminder.”
Refer a patient
Learn more about vascular services at WellSpan Health and refer a patient.