PHILADELPHIA — Patients who have undergone coronary bypass surgery have an increased risk of also having an abdominal aortic aneurysm, according to results from a single-center study with 752 patients.
Based on this finding, screening for an abdominal aortic aneurysm (AAA) in patients with a history of coronary artery bypass graft (CABG) is “very important,” Dr. Carlo A. Dall'Olmo said at the Vascular Annual Meeting.
“We believe that patients with a history of CABG should be added to the list of patients who are screened under the SAAAVE [Screening Abdominal Aortic Aneurysms Very Efficiently] Act,” said Dr. Dall'Olmo, a vascular surgeon in private practice in Flint, Mich. This federal law, which goes into effect next January, allows for Medicare reimbursement for one-time AAA screening by ultrasound in selected patients. Right now, the list of patients eligible for Medicare screening are men aged 65–75 years who are current or former smokers, and men and women aged 65–75 who have a family history of AAA.
Dr. Dall'Olmo and his associates are also starting a study to see whether patients with a history of coronary revascularization by percutaneous coronary intervention also have an increased prevalence of AAA.
Their current study included 517 men, of whom 47 (9.1%) were found by an ultrasound examination to have an AAA of 3.0 cm or greater in the anterior-posterior or transverse diameter. This compared with the usually reported prevalence of 3%–6% in men. In the group that Dr. Dall'Olmo and his associates studied, about two-thirds had not been previously diagnosed with an AAA. Six of the patients had aneurysms that were 5 cm or greater in diameter.
Of the 235 women screened, 12 (5.1%) had an AAA of 3.0 cm or greater, a rate much higher than the 1% reported prevalence for women in population-based studies. About half of the aneurysms had not been previously diagnosed, and two women had aneurysms that were 5 cm or more in diameter.
The prevalence went up sharply with smoking. Among men, never smokers had a 2.3% prevalence, former smokers had a 10.3% prevalence, and current smokers had an 18.6% prevalence of an AAA. In women, never smokers had a 1.6% prevalence, former smokers had a 6.9% prevalence, and in current smokers 18.7% had an AAA.
The prevalence rates also tracked higher with increased age. A history of diabetes or hypertension was not linked with an increased risk for AAA in these patients, Dr. Dall'Olmo said.