Should an 82-year-old woman with a history of smoking, who quit 10 years ago, and has carotid artery disease, be screened for an abdominal aortic aneurysm?

From the Guidelines

Screening for Abdominal Aortic Aneurysm in an 82-Year-Old Woman

Yes, an 82-year-old woman with a history of smoking, who quit 10 years ago, and has carotid artery disease, should be considered for screening for an abdominal aortic aneurysm (AAA) due to her age and history of smoking, which are significant risk factors for AAA development and rupture 1.

Risk Factors and Screening Recommendations

• Age and Sex: The patient's age of 82 years puts her in a higher risk category for AAA, as the risk increases with age, especially in those over 75 years 1.
• Smoking History: Although she quit smoking 10 years ago, her history of smoking significantly increases her risk of developing AAA, with studies suggesting a 15-fold increased risk in women who smoke 1.
• Carotid Artery Disease: The presence of carotid artery disease indicates atherosclerotic disease, which is a risk factor for AAA 1.
• Screening Guidelines: The 2022 ACC/AHA guideline and the 2024 ESC guidelines suggest that screening may be considered in women aged 75 years or older who are current smokers, hypertensive, or both, and in men aged 75 years or older, irrespective of smoking history 1.

Considerations for Screening

• Individualized Approach: The decision to screen should be individualized, taking into account the patient's overall health, life expectancy, and potential benefits and harms of screening and treatment 1.
• Ultrasound Screening: Ultrasound is the recommended imaging modality for AAA screening due to its high sensitivity and specificity, and non-invasive nature 1.

Given the patient's age, smoking history, and presence of carotid artery disease, screening for AAA with ultrasound should be considered to detect and potentially treat AAA before rupture, which has a high mortality rate 1.

From the Research

Screening for Abdominal Aortic Aneurysm

• The patient in question is an 82-year-old woman with a history of smoking, who quit 10 years ago, and has carotid artery disease.
• According to the study 2, there is a high frequency of abdominal aortic aneurysm in patients with carotid stenosis, suggesting that screening for abdominal aortic aneurysm may be warranted in this patient.
• The study 3 found that the prevalence of abdominal aortic aneurysm is highest in patients with peripheral arterial disease (PAD) or transient ischemic attack (TIA), stroke, or internal carotid artery stenosis (ICAS), which suggests that patients with carotid artery disease may be at increased risk.
• The study 4 also found that patients with abdominal aortic aneurysms are at high risk of other atherosclerotic disorders, including carotid artery disease and peripheral arterial disease, and recommends intensive medical optimization.
• However, the patient's age (82 years) is outside the range of the screening recommendations for abdominal aortic aneurysm, which are typically targeted at patients between 65-75 years old 5.
• Ultrasonography is an effective method for screening and monitoring abdominal aortic aneurysms, with high sensitivity and specificity 5, and may be considered as a screening tool for this patient.

Risk Factors

• The patient's history of smoking is a significant risk factor for abdominal aortic aneurysm, as well as other atherosclerotic diseases 6, 5.
• The patient's carotid artery disease is also a risk factor for abdominal aortic aneurysm, as shown in the study 2.
• The patient's age and sex are also risk factors for abdominal aortic aneurysm, as the disease is more common in older men and women 3, 4.

Screening Recommendations

• The study 3 recommends screening for abdominal aortic aneurysm in patients with PAD or TIA, stroke, or ICAS, particularly those with advanced age or tall stature.
• The study 2 recommends routine abdominal ultrasonic screening in patients with carotid stenosis.
• However, there is no clear recommendation for screening in an 82-year-old woman with a history of smoking and carotid artery disease, and the decision to screen should be individualized based on the patient's overall health and risk factors 5.