Putting Prevention into Practice

An Evidence-Based Approach

Screening for Abdominal Aortic Aneurysm

 

Am Fam Physician. 2020 May 15;101(10):621-622.

Related U.S. Preventive Services Task Force Recommendation Statement: Screening for Abdominal Aortic Aneurysm: Recommendation Statement

Author disclosure: No relevant financial affiliations.

Case Study

A 65-year-old man with no significant medical history presents to your clinic for a wellness visit. His social history includes smoking periodically in his 20s, and his family history includes a father who died from an abdominal aortic aneurysm (AAA) in his 60s. The patient wants to know whether he should be screened for AAA.

Case Study Questions

1. Based on the U.S. Preventive Services Task Force (USPSTF) recommendations, which of the following patients should be offered screening for AAA?

  • A. A 65-year-old man who currently smokes.

  • B. A 65-year-old man with a history of smoking.

  • C. A 65-year-old woman with no history of smoking and no family history of AAA.

  • D. A 65-year-old woman with a history of smoking.

2. Which one of the following statements about the treatment of AAA is correct?

  • A. Treatment with antibiotics or beta blockers reduces aneurysm growth.

  • B. Patients with a large aneurysm (aortic diameter of 5.5 cm or larger) should undergo prompt surgical repair.

  • C. Open surgery is the only way to repair an aneurysm.

  • D. Operative mortality associated with AAA is higher in men than in women.

3. According to the USPSTF recommendations, which one of the following screening tests for AAA is recommended?

  • A. Annual low-dose computed tomography.

  • B. Annual magnetic resonance imaging.

  • C. One-time abdominal duplex ultrasonography.

  • D. Physical examination.

  • E. Annual abdominal radiography.

Answers

1. The correct answers are A and B. The USPSTF recommends one-time screening for AAA with ultrasonography in men 65 to 75 years of age who have ever smoked (B recommendation).1 Additionally, the USPSTF recommends that clinicians selectively offer AAA screening with ultrasonography in men 65 to 75 years of age who have never smoked rather than routinely screening all men in this group (C recommendation). In determining whether this service is appropriate in individual cases, patients and physicians should consider the balance of benefits and harms on the basis of evidence relevant to the p

Author disclosure: No relevant financial affiliations.

References

1. Owens DK, Davidson KW, Barry MJ, et al. Screening for abdominal aortic aneurysm: US Preventive Services Task Force recommendation statement. JAMA. 2019;322(22):2211–2218.

2. Siu AL. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163(8):622–634.

3. Guirguis-Blake JM, Beil TL, Senger CA, et al. Primary care screening for abdominal aortic aneurysm: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2019;322(22):2219–2238.

This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and supporting documents on the USPSTF website (https://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/abdominal-aortic-aneurysm-screening1.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Putting Prevention into Practice published in AFP is available at https://www.aafp.org/afp/ppip.

 

 

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