dr. phil o’halloran surgical grand rounds. case. hs 65 year old male electively admitted for an...
DESCRIPTION
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: NormalTRANSCRIPT
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 55-64
336 (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.