Clinical Presentation:
The AAA may be present as a pulsatile mass within the abdomen and cause abdominal or back pain. An AAA causes severe onset of pain upon rupture and may result in death if not detected. Upon rupture the AAA produces symptoms such as lightheadedness, fast heart rate, shock and has a high rate of mortality.
Prevention of AAA:
According to the U.S. Preventive Services Task Force (USPSTF) men aged 65 to 75 who have ever smoked are recommended to have a one-time ultrasound screening for AAA. No recommendation for or against screening for AAA is made for men aged 65 to 75 who have never smoked. Routine screening for AAA among women is not enforced as a recommendation by the USPSTF(1).
Risks of AAA:
Kent et al retrospectively analyzed medical and questionnaire data from 3.1 million patients screened with ultrasound for abdominal aortic aneurysm (AAA) from 2003 to 2008. The analysis found that excess weight was associated with increased risk, whereas exercise and consumption of nuts, vegetables, and fruits were associated with reduced risk. Blacks, Hispanics, and Asians had lower risk of AAA than whites and Native Americans. The study also found that the risk of AAA increased with more years of smoking and total cigarettes smoked (based on packs-per-day estimates), while the risk went down the longer the patient lived after quitting smoking. Based on their findings from the database, Kent et al created a new scoring system that would assign points to different risk factors, with negative points for factors that decrease AAA risk. (2)
Assessment and Plan: Abdominal Aortic Aneurysm (AAA)
- According to the U.S. Preventive Services Task Force (USPSTF) men aged 65 to 75 who have ever smoked are recommended to have a one-time ultrasound screening for AAA.
- If there is a known AAA, for prevention of an AAA, or for family history of AAA: Patients should be advised to quit smoking, control blood pressure, reduce weight, reduce total cholesterol, reduce LDL, and reduce triglycerides. Please see these sections in Preventive Health Advisor for more information.
- Teach others to avoid smoking to reduce risk of AAA.
- A handful of walnuts or Brazil nuts per day may assist in improvement of cholesterol and artery health if not allergic to nuts and 5 servings or more of a variety of vegetables and fruits daily.
- Please see sections on weight loss, hyperlipidemia, and aerobic exercise if overweight and not obtaining enough exercise.
- Additional Screening recommendations by the U.S. Preventive Services Task Force (USPSTF): Guide to Clinical Preventive Services, 2012 Recommendations of the U.S. Preventive Services Task Force: http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section1.html
References:
1.Screening for Abdominal Aortic Aneurysm, Topic Page. February 2005. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsaneu.htm
2.Kent KC, Zwolak RM, Egorova NN, Riles TS, Manganaro A, Moskowitz AJ, Gelijns AC, Greco G.Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg. 2010; 52(3): 539-48. http://www.ncbi.nlm.nih.gov/pubmed/20630687