Jain Paarth, DiMuzio Paul, Nooromid Michael, Salvatore Dawn, Abai Babak
Sidney Kimmel Medical College of Thomas Jefferson University, Piladelphia, PA.
Division of Vascular and Endovascular Surgery, Thomas Jefferson University Hospital, Piladelphia, PA.
J Vasc Surg. 2025 Apr;81(4):877-886.e3. doi: 10.1016/j.jvs.2024.12.005. Epub 2024 Dec 17.
For men ages 65 to 75 years without a smoking history and for women ages 65 to 75 years with a smoking history, the United States Preventative Service Task Force recommends that primary care providers (PCPs) use their clinical judgement when offering abdominal aortic aneurysm (AAA) screening. This study describes the trends in screening for these cohorts, identifies factors that may influence screening rates, and compares outcomes between screened and unscreened patients.
The TriNetX population database was queried for subjects with routine PCP visit between ages 65 to 75 from 2007 to 2023 to create cohorts of male smokers, male nonsmokers, and female smokers. Prevalence and 1- and 3-year incidences of AAA screening by ultrasound and computed tomography scans/magnetic resonance imaging (CT/MRI) were calculated. Screened and unscreened patients' demographics, diagnoses, and medications were compared. Rates of AAA diagnosis and repair were compared between unmatched screened and unscreened patients.
Screening for all groups peaked in 2023. Male smokers had the highest screening prevalence (21.2%), followed by male nonsmokers (3.1%) and female smokers (0.90%). The 1-year incidence of screening increased for male smokers, peaking at 8.2% in 2021. The 1-year incidence plateaued at 1.9% for male nonsmokers in 2020 and remained between 0.25% and 0.35% for female smokers for the whole observation period. By 2023, 23.6%, 14.3%, and 24.3% of male smokers, male nonsmokers, and female smokers had been screened via CT/MRI, respectively, with CT/MRI comprising the majority of screening events for all three cohorts. Hyperlipidemia and statin use were associated with screening for all groups (P < .05), whereas a personal history of coronary artery disease was associated with no screening. Screening for male nonsmokers was associated with hypertension, diabetes, and chronic pulmonary obstructive disease (P < .05). Screening in female smokers was associated with family history of coronary artery disease (odds ratio, 1.50; P < .001). For all groups, screening was associated with unruptured AAA diagnosis and endovascular aortic repair (P < .05). Screened female smokers had similar rates of AAA diagnosis as male nonsmokers (4.58% and 4.37%, respectively).
AAA screening in all at-risk populations increases diagnosis and treatment of AAA, but the screening rate is low for all groups, even with increasing CT/MRI use. Patients with strong risk factors for AAA are not undergoing screening. Collaboration with PCPs is necessary to increase screening rates and ensure that patients with the most clinically consequential risk factors are managed appropriately.
对于65至75岁无吸烟史的男性以及65至75岁有吸烟史的女性，美国预防服务工作组建议初级保健提供者（PCP）在提供腹主动脉瘤（AAA）筛查时运用临床判断力。本研究描述了这些队列的筛查趋势，确定了可能影响筛查率的因素，并比较了筛查和未筛查患者的结局。
查询TriNetX人群数据库，以获取2007年至2023年期间年龄在65至75岁之间进行常规PCP就诊的受试者，以创建男性吸烟者、男性非吸烟者和女性吸烟者队列。计算通过超声以及计算机断层扫描/磁共振成像（CT/MRI）进行AAA筛查的患病率、1年和3年发病率。比较筛查和未筛查患者的人口统计学、诊断和用药情况。比较未匹配的筛查和未筛查患者之间的AAA诊断和修复率。
所有组的筛查率在2023年达到峰值。男性吸烟者的筛查患病率最高（21.2%），其次是男性非吸烟者（3.1%）和女性吸烟者（0.90%）。男性吸烟者的1年筛查发病率有所上升，在2021年达到峰值8.2%。男性非吸烟者的1年发病率在2020年稳定在1.9%，女性吸烟者在整个观察期内保持在0.25%至0.35%之间。到2023年，分别有23.6%、14.3%和24.3%的男性吸烟者、男性非吸烟者和女性吸烟者通过CT/MRI进行了筛查，CT/MRI占所有三个队列筛查事件的大部分。高脂血症和他汀类药物的使用与所有组的筛查相关（P <.05），而冠状动脉疾病个人史与未筛查相关。男性非吸烟者的筛查与高血压、糖尿病和慢性阻塞性肺疾病相关（P <.05）。女性吸烟者的筛查与冠状动脉疾病家族史相关（比值比，1.50；P <.001）。对于所有组，筛查与未破裂AAA诊断和血管内主动脉修复相关（P <.05）。筛查的女性吸烟者的AAA诊断率与男性非吸烟者相似（分别为4.58%和4.37%）。
对所有高危人群进行AAA筛查可增加AAA的诊断和治疗，但所有组的筛查率都很低，即使CT/MRI的使用有所增加。具有强烈AAA危险因素的患者未接受筛查。与PCP合作对于提高筛查率并确保对具有最具临床意义危险因素的患者进行适当管理是必要的。
