Screening for AAA Recommended in Men Over 59 with TIA or Stroke

By Patrice Wendling

Elsevier Global Medical News

CHICAGO — One of every nine men over age 59 years with a diagnosis of stroke or transient ischemic attack had an abdominal aortic aneurysm in a prospective study of 499 patients.

Among all patients admitted for stroke or TIA, the prevalence of abdominal aortic aneurysm (AAA) on ultrasound evaluation was 5.8%. This is comparable to the prevalence in other populations and was not significant.

AAA prevalence was 11.1% in a subgroup of 235 men aged 59 years and older (median 72 years), Dr. Niels H.A. Van Lindert and colleagues reported at the annual meeting of the Radiological Society of North America. The prevalence in the subgroup was significantly higher than the 4.0%-8.1% prevalence found in three recent population-based screening studies in men over 59 years of age.

The finding could lead to improved screening and earlier treatment of this high-risk group, said Dr. Van Lindert, of the Gelre Hospitals Apeldoorn (the Netherlands). Although the use of ultrasound is noninvasive, low-cost, accurate, and fast, most abdominal aneurysms are found by chance in men of older age and with a history of smoking.

“In our group, 55% of aneurysms were in nonsmokers, which meant that detection would not have occurred following task force rules,” he said.

The United States Preventive Services Task Force (USPSTF) recommends a one-time ultrasonography screening of all men aged 65-75 years with a history of smoking.

The USPSTF makes no recommendation for or against screening for AAA in men aged 65-75 years who have never smoked, and recommends against routine screening for AAA in women.

Dr. Van Lindert recommended that all men older than 59 years of age admitted with a stroke or TIA should be screened for an AAA.

Further studies are needed to determine the cost-benefit aspects of screening in this patient population with a shorter life expectancy, he said.

Abdominal aortic diameter was measured by ultrasonography in 518 patients visiting their neurology department with a primary diagnosis of stroke or TIA between January 2002 and January 2005. In all, 373 had suffered an ischemic stroke, 125 a TIA, and 20 a cerebral hemorrhage. Ultrasonography was not performed in 19 for various reasons. Their median age was 71 years, and 61% were men.

An aneurysm was defined as an abdominal aorta with a diameter of at least 3.0 cm. Maximum aneurysm diameter was 3.0-3.9 cm in 18 patients, 4.0-4.9 cm in 6 patients, and 5.0 cm or more in 5 patients.

The investigators found no association between AAA prevalence and cerebrovascular accident subtype or smoking, both of which have been previously identified as risk factors for AAA.

The investigators reported no conflicts of interest.

When asked to comment on this article, Dr. Brian G. Rubin stated: “It is not surprising that aneurysm disease, stroke (in this study predominantly ischemic infarct, most likely from carotid disease), and peripheral arterial disease cluster in individual patients. What is remarkable is the high prevalence of aortic dilation in elderly Dutch men with a stroke, in this series 11.1%. It is unclear if this finding can be generalized across a broader racial and geographic distribution. While ultrasound is an excellent, low risk screening tool, the applicability of these findings to wider patient populations remains unknown.”

Contact the Editor at vascularspecialist@vascularsociety.org.

Dr. Rubin is a Professor of Surgery in the Section of Vascular Surgery at the Washington University School of Medicine Saint Louis, MO. He also is an associate medical editor for Vascular Specialist.

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