From the Guidelines
Yes, an 82-year-old woman with a history of smoking and carotid artery disease should be considered for screening for an abdominal aortic aneurysm (AAA).
Key Points
- According to the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1, ultrasound screening for detection of AAA is reasonable in women who are ≥65 years of age who have ever smoked, which is classified as a Class IIa recommendation.
- The 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1 also suggest that screening for AAA with duplex ultrasound (DUS) may be considered in women aged ≥75 years who are current smokers, hypertensive, or both, which is classified as a Class IIb recommendation.
- The patient's history of smoking and carotid artery disease increases her risk for AAA, and screening may help prevent rupture and associated mortality.
- The growth of AAA is nonlinear, with a mean rate of 2.6 mm/y for AAA <5.0 cm, and may accelerate in the setting of smoking or a family history of AAA 1.
- Ultrasound screening should be targeted toward those at the greatest risk for AAA and growth, with the goal of preventing rupture and associated mortality 1.
Considerations
- The patient's age and smoking history put her at increased risk for AAA, and screening may be beneficial in preventing rupture and associated mortality.
- However, the guidelines do not provide a clear recommendation for screening in women over 75 years of age without other risk factors, and the decision to screen should be individualized based on the patient's overall health and risk factors.
From the Research
Screening for Abdominal Aortic Aneurysm (AAA)
- The patient in question is an 82-year-old woman with a history of smoking and carotid artery disease, which are significant risk factors for vascular diseases 2, 3.
- Studies have shown that smoking is a substantial risk factor for the development of abdominal aortic aneurysm, with a significant increase in risk for men aged 65-75 years with a smoking history 2.
- Carotid artery disease is also a risk factor for AAA, and screening for AAA is recommended in high-risk individuals, such as those with a history of smoking and carotid artery disease 4.
- Ultrasonography is an effective method for screening and monitoring abdominal aortic aneurysms, with high sensitivity and specificity 4.
Risk Factors and Screening Recommendations
- The patient's history of smoking and carotid artery disease puts her at high risk for AAA, and screening is recommended to detect the condition early 4, 2.
- Current guidelines do not recommend population-wide screening for asymptomatic carotid artery stenosis, but selective screening for high-risk individuals, such as those with a history of smoking and carotid artery disease, may be considered 5, 6.
- The patient's age and risk factors suggest that screening for AAA may be beneficial, and ultrasonography is a suitable method for screening 4.
Management and Prevention
- Smoking cessation is a crucial intervention for preventing further enlargement of small aortic aneurysms and reducing the risk of vascular diseases 4, 2.
- Medical management, including antiplatelet therapy, high-dose statins, blood pressure control, and smoking cessation, is essential for preventing stroke and other cardiovascular events in patients with carotid artery disease and AAA 6.