A majority of patients who undergo repair for ruptured abdominal aortic aneurysms (AAAs) do not qualify for screening, according to a study published online in the August issue of the Journal of Vascular Surgery.
Kirsten D. Dansey, M.D., from the Beth Israel Deaconess Medical Center in Boston, and colleagues used the National Inpatient Sample (2004 to 2015) to identify ruptured (65,125) and intact (461,191) AAA admissions and repairs. Treatment and in-hospital mortality were compared between patients meeting the criteria for screening and those who did not.
The researchers found that an estimated 68 percent of admitted patients and 59 percent of patients who had undergone repair for ruptured AAAs did not meet the criteria for screening. Among patients who did not qualify for screening, 63 percent were older than 75 years, while 24 percent were younger than 65 years, and 36 percent were women. There was an increase in endovascular AAA repair for ruptured AAAs from 10 percent in 2004 to 55 percent in 2015, with operative mortality of 35 percent. Similarly, endovascular AAA repair increased for intact AAAs from 45 percent in 2004 to 83 percent in 2015, with operative mortality of 2.0 percent.
“The current screening guidelines are not based on modern practice data,” Dansey said in a statement. “The advantage of using endovascular AAA repair is missed when calculating which patients would benefit from this low-risk procedure. Patients aged >75 years constituted more than one half of the patients admitted with AAA rupture and represent a critical and increasing screening-ineligible population.”