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Guirguis-Blake JM, Beil TL, Sun X, et al. Primary Care Screening for Abdominal Aortic Aneurysm: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Jan. (Evidence Syntheses, No. 109.)

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Primary Care Screening for Abdominal Aortic Aneurysm: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet].

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Appendix JAAA Clinical Recommendations From Expert Groups

Expert GroupTarget GroupStarting AgeStopping AgeFrequency of ScreeningSurveillanceIntervention(s)Recommendation Grade
USPSTF, 20051Men who have ever smoked6575One timeNREVAR or OSR if AAA ≥5.5 cmB Recommendation
The service is recommended.
ACC, 2005168Men who are siblings or offspring of patients with AAA≥6075One timeEvery 6–12 months if AAA 4.0–5.4 cm; every 2–3 y if AAA smaller than 4.0 cmElective open repair if AAA ≥5.5 cm and low- or average-risk patient; endograft repair if AAA ≥5.5 cm and high-risk patientClass I
Recommendation that procedure or treatment is useful/effective.
Level of Evidence: B
Evidence from single RCT or nonrandomized studies.
ACC, 2005168Men ages 65–75 y who ever smoked6575One timeEvery 6–12 months if AAA 4.0–5.4 cm; every 2–3 y if AAA smaller than 4.0 cm.Elective open repair if AAA ≥5.5 cm and low- or average-risk patient; endograft repair if AAA ≥5.5 cm and high-risk patient.Class IIA
Recommendation in favor of treatment or procedure being useful/effective.
Level of Evidence: B
Some conflicting evidence from single RCT or nonrandomized studies.
CSVS, 2007167Men6575Every 3–5 yPolicy is unclear for AAA 4.4–5.4 cm; annually if AAA 3.0–4.4 cmSurgical repair (not specified) if AAA ≥5.5 cmGrade 1A
Evidence obtained from at least 1 properly randomized controlled trial or 1 large epidemiological study. Evidence sufficient for universal use.
CSVS, 2007167Women age 65 y or older with multiple risk factors (smoking history, CVD, family history of AAA)65NREvery 3–5 yPolicy is unclear for AAA 4.4–5.4 cm; annual rescreening if AAA 3.0–4.4 cmSurgical repair (not specified) if AAA ≥5.5 cmGrade 3C
Opinions of respective authorities, based on clinical experience, descriptive studies, or reports of expert committees. Evidence not based on RCTs.
CSVS, 2007167Women age 65 y or older, all adults age <65 y, and men age 75–80 yNANANANANAGrade 3C
Opinions of respective authorities, based on clinical experience, descriptive studies, or reports of expert committees. Evidence not based on RCTs.
CCS, 2005169Men ages 65–74 yNRNREvery 3–5 yRepeat ultrasound every 6 months if AAA ≥4.5 cm, repeat in 1 y if AAA 4.0–4.5 cm; repeat in 2 y if AAA 3.5–3.9 cm; repeat in 3 y if AAA 3.1–3.4 cmReferral to vascular surgeon if AAA ≥4.5 cm; surgical repair (not specified) if AAA >5.5 cm in men and >4.5 in women. Consider surgical repair if growth >1 cm in 1 yGrade 1A
Evidence obtained from at least 1 properly randomized controlled trial or 1 large epidemiological study. Evidence sufficient for universal use.
CCS, 2005169Women age 65 y or older with CVD and positive family history of AAA65NREvery 3–5 yRepeat ultrasound every 6 months if AAA ≥4.5 cm, repeat in 1 y if AAA 4.0–4.5 cm; repeat in 2 y if AAA 3.5–3.9 cm; repeat in 3 y if AAA 3.1–3.4 cmReferral to vascular surgeon if AAA ≥4.5 cm; surgical repair (not specified) if AAA >5.5 cm in men and >4.5 cm in women. Consider surgical repair if growth >1 cm in 1 yGrade 3C
Opinions of respective authorities, based on clinical experience, descriptive studies, or reports of expert committees. Evidence not based on RCTs.
SVS, 200924Men age 50 y or older and family history of AAA5064One timeEvery 6 months if AAA 4.5–5.4 cm; at 1 y if AAA 3.5–4.4 cm; repeat in 3 y if AAA 3.0–3.4 cm; repeat in 5 y if AAA 2.6–2.9 cmSurgical repair if fusiform AAA ≥5.5 cm, secular AAA, young healthy patients and especially women with AAA 5.0–5.4 cm, statins, smoking cessation, ACE inhibitors/angiotensin receptor blockers; EVAR is associated with lower risk than OSRGrade 3C
Opinions of respective authorities, based on clinical experience, descriptive studies, or reports of expert committees. Evidence not based on RCTs.
SVS, 200924Men age 65 y or older; as early as 55 yearsfor those with a family history of AAA65 (55 if family history of AAA)NROne timeRepeat every 6 months if AAA 4.0–4.5 cm; annual examination if AAA 3.0–4.0 cmRefer to a vascular specialist if AAA >4.5 cm; surgical repair if >5.5 cm; EVAR is associated with lower risk than OSRLevel of recommendation: Strong
Benefits > Risks
Quality of evidence: High
Additional research is considered very unlikely to change confidence in the estimate of effect.
SVS, 200924Women age 65 y or older with a family history of AAA or who have smoked65NROne timeRepeat every 6 months if AAA 4.0–4.5 cm; annual examination if AAA 3.0–4.0 cmRefer to a vascular specialist if AAA >4.5 cm; surgical repair if >5.5 cm; EVAR is associated with lower risk than OSRLevel of recommendation: Strong
Benefits > Risks
Quality of evidence: Moderate
Further research is likely to have an important impact on in the estimate of effect.

Abbreviations: AAA = abdominal aortic aneurysm; ACC = American College of Cardiology; ACE = angiotensin-converting enzyme; CCS = Canadian Cardiovascular Society; CSVS = Canadian Society for Vascular Surgery; CVD = cardiovascular disease; EVAR = endovascular aneurysm repair; NR = not reported; OSR = open surgical repair; RCT = randomized, controlled trial; SVS = Society of Vascular Surgery; USPSTF = U.S. Preventive Services Task Force.

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