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Protocol - Abdominal Aortic Aneurysm

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Description:

Measure to assess the presence of an abdominal aortic aneurysm through the use of ultrasound.

Protocol:

1. Have you ever been diagnosed by a doctor as having an abdominal aortic aneurysm?

[] Yes

[] No

If "Yes," ask question 2.

2. Have you had surgery or other repair for this aneurysm?

[] Yes

[] No

3. Abdominal Ultrasound Protocol

An ultrasound scan of the abdominal aorta is performed using a portable ultrasound machine (Hitachi ultrasound scanner EUB-405, Hitachi Medical Corporation, Tokyo, Japan). The maximum transverse diameter of the aorta in the transverse plane, and the maximum anterior-posterior diameter in the longitudinal plane, are measured with calipers, and images are recorded on thermal paper. The largest diameter of these two readings is recorded as the maximum aortic diameter for each. A hardcopy should be kept of all scans.

After initial screening, the scanned group is subdivided into those who had an abdominal aortic aneurysm (maximum aortic diameter on ultrasound ≥3 cm), those in whom no aneurysm was detected, and those in whom the aorta could not be visualized. Arrangements should be made with a personal physician to follow up with patients who had an abdominal aortic aneurysm with repeat scans at intervals related to the aortic size.

Patients are not given their results at the clinic. A radiologist reviews all abnormal scans and a subsample of normal scans. At the completion of screening, results are sent to the patients' family doctor with letters for the doctors to send to the patients should they feel it appropriate.

Patients who have a normal aorta (<3 cm diameter) and those whose aortas are not visualized are not rescanned. Patients with an aortic diameter of 3.0-4.4 cm should be rescanned at yearly intervals, whereas those with an aortic diameter of 4.5-5.4 cm should be rescanned at 3-month intervals. Urgent referral to a vascular consultant should be recommended for patients with an aortic diameter of 5.5 cm or greater.

Protocol Name from Source:

The Expert Review Panel has not reviewed this measure yet.

Availability:

Publicly available

Personnel and Training Required

An interviewer who is trained to conduct personal interviews with individuals from the general population is required. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews.* The interviewer should be trained to prompt respondents further if a "don't know" response is provided.

*There are multiple modes to administer this question (e.g., paper-and-pencil and computer-assisted interviews).

A certified and trained technician is required to complete the abdominal ultrasound. A physician is required to interpret the results.

Equipment Needs

Portable ultrasound machine (Hitachi ultrasound scanner EUB-405, Hitachi Medical Corporation, Tokyo, Japan)

Calipers

Thermal paper

Requirements
Requirement CategoryRequired
Major equipment Yes
Specialized training Yes
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered question, Non-invasive radiologic assessment

Life Stage:

Adult

Participants:

San Diego Population Study (SDPS): 40–79 years old

The Multicentre Aneurysm Screening Study (MASS): men aged 65–74 years*

*Note: The Cardiovascular Working Group deems it appropriate for this protocol to be used with women over 45 years old in addition to men.

Specific Instructions:

All respondents who are considered to be in a risk group should be screened using an ultrasound scan of the abdominal aorta regardless of their responses to questions 1 and 2. See the "General References" section for sources of information to identify those at risk for abdominal aortic aneurysm.

Selection Rationale

Few studies assess the presence of an abdominal aortic aneurysm. The protocol from the Multicentre Aneurysm Screening Study (MASS) was selected because its protocol describes how to perform an abdominal ultrasound, which is the main diagnostic tool for assessing the size of an abdominal aortic aneurysm.

Language

English, Spanish

Standards
StandardNameIDSource
Common Data Elements (CDE) Person Abdominal Aortic Aneurysm Indicator 2935420 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Abdominal aortic aneurysm proto 62399-1 LOINC
Derived Variables

None

Process and Review

The Expert Review Panel has not reviewed this measure yet.

Source

U.S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung and Blood Institute. San Diego Population Study (SDPS) (source for questions 1 and 2).

Ashton, H. A., Buxton, M. J., Day, N. E., Kim, L. G., Marteau, T. M., Scott, R. A., Thompson, S. G., & Walker, N. M.; Multicentre Aneurysm Screening Study Group. (2002). The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: A randomised controlled trial. Lancet, 360(9345), 1531–1539 (source for question 3).

General References

Singh, K., Bonaa, K. H., Jacobsen, B. K., Bjork, L., & Solberg, S. (2001). Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study—The Tromsø Study. American Journal of Epidemiology, 154(3), 236–244.

Alcorn, H. G., Wolfson, S. K., Jr., Sutton-Tyrrell, K., Kuller, L. H., & O'Leary, D. (1996). Risk factors for abdominal aortic aneurysms in older adults enrolled in the Cardiovascular Health Study. Arteriosclerosis, Thrombosis, and Vascular Biology, 16, 963–970.

Protocol ID:

41001

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX041001_AAA_Surgery PX041001020000 Have you had surgery or other repair for this aneurysm? 4 N/A
PX041001_Ever_Have_Abdominal_Aortic_Aneurysm PX041001010000 Have you ever been diagnosed by a doctor as having an abdominal aortic aneurysm? 4 N/A
PX041001_Max_Anterior_Posterior_Diameter PX041001030300 Maximum anterior-posterior diameter (cm) in the longitudinal plane. 4 N/A
PX041001_Max_Aortic_Diameter PX041001030400 Maximum aortic diameter (cm). 4 N/A
PX041001_Max_Transverse_Diameter PX041001030200 Maximum transverse diameter (cm) of the aorta. 4 N/A
PX041001_Ultrasound_Image_ID PX041001030500 Ultrasound scan image ID. 4 N/A
PX041001_Ultrasound_Machine PX041001030100 Ultrasound machine name and model. 4 N/A
Research Domain Information
Measure Name:

Abdominal Aortic Aneurysm

Release Date:

September 24, 2009

Definition

This measure assesses the presence of an abdominal aortic aneurysm.

Purpose

To assess the presence of an abdominal aortic aneurysm, often associated with coronary heart disease, peripheral vascular disease, or stroke, so that proper treatment is performed to prevent rupture of the aneurysm or further damage to the heart.

Keywords

abdominal aortic aneurysm, ultrasound, aortic, personal history, Cardiovascular