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New aneurysm screening guidelines
for male smokers
The aorta is the body’s largest blood vessel. It begins
at the left ventricle, the heart’s main pumping chamber,
heads toward the neck for a few inches, and then travels down the back
of your chest and into the abdomen. The seven-inch stretch of the vessel
in the abdomen is called the abdominal aorta. In some people,
a section of the abdominal aorta may weaken and bulge, a condition
called abdominal aorticaneurysm (AAA).
AAAs are more likely to form in people who have atherosclerosis or
who have risk factors that can cause atherosclerosis such as high cholesterol
levels, high blood pressure, diabetes, or smoking. Abdominal aortic aneurysms
are more common in men than in women, and this risk is heightened in
men who smoke or used to smoke. Also, people ages 65 and older are at
the highest risk for abdominal aortic aneurysm. AAAs also tend to run
in families.
If the aneurysm becomes too large, it can burst and cause rapid, profuse,
and often fatal bleeding. Doctors follow patients who have AAAs closely.
But how does a person know whether or not they have an AAA? Until recently,
clinicians have checked for this problem during a person’s health
checkup to try to feel for a bulging aneurysm in the belly. If a doctor
thinks he or she feels an aneurysm, an ultrasound or CT scan is ordered.
But no doctor’s fingers are perfect at detecting aneurysms, and
until recently there have been no clear guidelines on screening people
for this problem.
That changed in January 2005, when the U.S. Preventive Services Task
Force (USPSTF) suggested that men between the ages of 65 and 75 who have
ever smoked (both current and former smokers), be screened for abdominal
aortic aneurysm through a one-time ultrasound examination. This is the
first time abdominal aortic aneurysm screening has been addressed by
the USPSTF. Its new recommendations result from a review of four research
trials on the benefits of screening for AAA. One of these studies, published
in a 2002 Lancet article, examined 67,800 men ages 65 to 75,
performing an ultrasound scan for AAA on half. Researchers discovered
that the risk of death from abdominal aortic aneurysm was 42% lower in
those men who were screened versus those who weren't. Screening identified
larger AAAs, leading to surgical intervention that saved lives.
When an abdominal aortic aneurysm grows to more than 2 inches (5.5 centimeters)
across, the chance it will burst begins rising dramatically. A burst aneurysm
usually has disastrous consequences — ruptured AAAs kill more than
15,000 Americans a year. New evidence shows that screening and surgery
for AAAs can dramatically reduce this number.
February 2005 Update
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