From the Guidelines
For a 75-year-old male with normal abdominal aortic aneurysm screening results, no further AAA-specific screening is typically needed. Since his screening was normal, indicating his aorta is of normal size, he does not require ongoing surveillance for this particular condition. However, he should continue regular primary care visits for age-appropriate preventive care, including management of cardiovascular risk factors such as hypertension, hyperlipidemia, and diabetes if present. Smoking cessation is crucial for those who smoke, as tobacco use significantly increases AAA risk, as noted in the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1. The patient should report any new abdominal or back pain promptly to his physician. This approach aligns with recommendations for screening and management outlined in the guidelines, which emphasize the importance of screening in specific high-risk populations but do not mandate ongoing screening for those with normal results, especially considering the low likelihood of developing a clinically significant AAA later in life, as suggested by the natural history of AAAs and the guidelines' focus on targeted screening 1. Key aspects of his care should include:
- Management of cardiovascular risk factors
- Smoking cessation if applicable
- Regular primary care visits for preventive care
- Prompt reporting of any new symptoms such as abdominal or back pain.
From the Research
Next Steps for a 75-year-old Male with Normal Abdominal Aortic Aneurysm Screening Test Results
- The patient's abdominal aorta is intact with no bulge, indicating a normal screening result.
- According to 2, screening for abdominal aortic aneurysms (AAAs) reduces aneurysm-related mortality, and the U.S. Preventive Services Task Force and American Heart Association recommend screening for men aged 65 to 75 years with a familial or smoking history.
- Since the patient has already undergone screening and has a normal result, the next steps would focus on maintaining a healthy lifestyle and managing any existing cardiovascular risk factors.
- As stated in 3, patients with peripheral arterial disease (PAD) are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from coronary artery disease, and should be treated with statins, antiplatelet drugs, and ACE inhibitors.
- Additionally, 4 suggests that treatment for hypertension and with statins may play an important role in reducing the prevalence of AAA, and that lifestyle changes and treatment of cardiovascular risk factors may be equally important as smoking cessation in preventing AAA occurrence.
- The patient's lipid profile should be monitored, as high LDL cholesterol has been associated with small abdominal aortic aneurysms, as reported in 5 and 6.
- Regular follow-up appointments with the patient's primary physician should be scheduled to monitor their overall health and adjust treatment plans as necessary.