Screening and preoperative imaging of candidates for conventional repair of abdominal aortic aneurysm

Abstract

This article summarizes considerations in screening for abdominal aortic aneurysm (AAA) and preoperative imaging before conventional surgical repair. Because death of this relatively common disease can be prevented by an effective treatment, there is great interest in early detection and elective repair. The prevalence of AAA in older adults (65 to 80 years of age) varies from 4% to 7%. Factors associated with AAA include smoking, age, coronary artery disease, high serum cholesterol level, family history, and hypertension. A higher prevalence of AAA has been found among first-degree relatives of AAA patients, particularly in men, and smoking is an important factor in the development and progression of AAA. Screening for AAA may be appropriate in male patients older than 65 years with a smoking history, particularly current smokers, who have carotid occlusive disease, coronary artery disease, or lower extremity occlusive disease. Ultrasound is the screening method of choice and has the benefit of being inexpensive and noninvasive. Preoperative imaging serves mainly to establish the indication for operation. The vascular surgeon comfortable with discovering potentially confusing anatomic configurations or adverse extensions of pathology at the time of operation may not require any imaging beyond ultrasound. Specific indications for arteriography include suggestion of juxtarenal aneurysm by ultrasound or physical examination, clinical evidence of lower extremity arterial occlusive disease, uncontrolled hypertension or unexplained creatinine elevation, or prior arterial reconstruction. Spiral computed tomography (CT) scan with 3-dimensional reconstruction and gadolinium magnetic resonance (MR) angiography are increasingly useful alternatives to contrast arteriography.