Recommendations on screening for abdominal aortic aneurysm in primary care.

CMAJ | SEPTEMBER 11, 2017 | VOLUME 189 | ISSUE 36 E1137 A n abdominal aortic aneurysm (AAA) results from a weakening in a section of the aortic wall in the abdomen, which bulges because of pressure from blood flow to form an aneurysm.1 The aneurysm may grow and eventually rupture, causing death from hemorrhage.1 It is estimated that each year, 20 000 Canadians receive a diagnosis of AAA, and that between 2009 and 2013, about 1244 people died each year from an AAA.2,3 Because AAA is usually asymptomatic before rupture,1 screening could provide an opportunity to identify, monitor and treat to prevent a rupture. Treatments for AAA include surgery to insert a graft inside the aorta or an endovascular procedure in which a graft is inserted through a groin incision and expanded in the aorta. Long-term outcomes are similar, although endovascular repair is less invasive and has lower perioperative mortality than surgical repair.4 Male sex is an important risk factor and AAA prevalence among men aged 65 to 80 years is four to six times higher than in women of the same age.5,6 Smoking is associated with formation, dilation and rupture of AAA.7,8 Other risk factors for the development of an AAA include advanced age9 and family history of AAA.10,11 Coronary artery disease, atherosclerosis, hypercholesterolemia and hypertension have weaker associations with AAA.8,12 Patients with diabetes appear less likely to develop AAA.13