Dr. Phil O’Halloran

Surgical Grand Rounds

Case.

•HS 65 year old male

•electively admitted for an EVAR on the.

•Pilot Screening programme

AAA Size (cm) = 5.62

Case.•BKGD: Nil of significance.

•Meds: NKDA

•Smoker : 10/day 40 years.

•Pre-op Work up: Echo - EF 55%

•Underwent endurant bifuracted repair of AAA.

Lipitor 10mg od po

PFT’s: Normal

Post Op

•Transfer back to Ward.

•Normal bloods day 1 post-op.

•Eating and Drinking.

•Mobilizing.

•Discharged well.

AAA Screening.

•Should we be doing it?

AAA Screening

NHS Abdominal Aortic Aneurysm Screening Programme

AAA Screening -Why?

•8:1

•4% of men aged 65-74.

•Significant Morbidity & Mortality.

•Vascular Disease = 40% of UK deaths.

•Family History.

•Smoking / Hypertension.

AAA Screening

Lancet 2002; Nov 16; 360 (9345): 1531-9.

MASS Study

MASS Study

MASS Study•42% reduction of risk

in the invited group.

•Similar mortality rate in those who DNA and control group.

•Substantial benefit of AAA Screening

(P value: 0.0002)

.

Cosford PA, Leng GC. Screening for abdominal aortic aneurysm. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD002945. DOI: 10.1002/14651858.CD002945.pub2.

• Making the Case for Cardiovascular Screening in Irish Males: Detection of Abdominal Aortic Aneurysms, and Assessment of Cardiovascular Risk Factors

• M. Brosnan b, C.G. Collins a, D.S. Moneley a, C.J. Kelly a,b, A.L. Leahy a,b,*

• a Department of Surgery, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin 9, Ireland

• b Department of Vascular Diagnostic Unit, Connolly Hospital, Blanchardstown, Dublin 15, Ireland

• Eur J Vasc Endovasc Surg (2009) 37, 300e304

Irish Pilot Study.

•April 2006 - Decemeber 2007.

•Males 55-75 invited for screening.

•GP register (N = 1414)

•904 accepted: 568 (63%) aged 55-64336 (37%) aged 64-75

Irish Pilot Study.•17/904 ( 1.9%) previously

undiagnosed aneurysm detected.

•Sizes ranging from 3-5.8cm

•0.6% in 55-64 age group.

•4.2% in 65-75 age group (p<0.01)

Conclusion AAA screening in 65-75 age group in Ireland is

justified.