NEW YORK (Reuters Health), May 5 - Some men having coronary artery bypass graft (CABG) surgery -- especially smokers -- should also be screened for abdominal aortic aneurysms (AAA), even if they're younger than screening guideline thresholds, French researchers suggest.
"According to present guidelines, AAA screening is recommended only for men aged 65 to 75 years with smoking histories," say lead author Dr. Annabelle Dupont and colleagues. "Had we respected the recommendation ... only three AAAs of the 15 diagnosed in the total study population would have been detected."
The prevalence of AAA was nearly 25% in one group of patients in their series, according to their April 23 online paper in the American Journal of Cardiology.
Dr. Dupont from University of Lille Nord de France and colleagues studied 217 patients with severe coronary artery disease undergoing elective bypass surgery. The cohort was 87% male, with a mean age of 64 years.
Postoperative abdominal echocardiography showed asymptomatic AAAs in 15 patients (6.9%). The mean infrarenal aortic diameter in these patients was 35.3 mm. Two patients with aortic diameters above 50 mm were referred for surgical treatment.
All AAAs were in men over 54 years old (median age, 67). Seven were in men ages 54 to 65, and five were in men older than 75.
All of the men with AAAs were current or former smokers; six had histories of peripheral arterial disease and four had coronary artery stenosis.
Smoking, symptomatic peripheral arterial disease, significant coronary artery stenosis, and larger femoral and popliteal diameters were all significantly associated with AAA.
Among males younger than 75 years old, those with concomitant peripheral arterial disease and/or coronary artery stenosis had a significantly higher prevalence of AAA (6/25, 24%) compared to those without these findings (4/91, 4.4%) (p=0.007).
"Despite the relatively small size of the study population, these data suggest that severe coronary artery disease could be associated with accelerated AAA development and that limiting the screening of AAA to men aged 65 to 75 years is not appropriate in men who undergo CABG," the researchers conclude.
"Larger community-based studies, including short- and long-term follow-up and cost-benefit evaluation, would confirm our results and may optimize AAA screening guidelines in patients who undergo CABG," they say.
In the meantime, the authors add, their findings justify "consideration of AAA screening in this subgroup of in-hospital patients."
Am J Cardiol 2010.
Last Updated: 2010-05-04 14:46:30 -0400 (Reuters Health)
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