A 67-year-old male seeks follow-up after a screening ultrasound at a health fair showed an abdominal aortic aneurysm. He has no symptoms and specifically denies claudication. He smoked 1-2 packs of cigarettes per day for 35 years and stopped 10 years ago. He has been told that his cholesterol was high in the past.
His temperature is 37.1 C (98.7 F) , blood pressure is 142/92 mm Hg, pulse is 72/min and respirations are 14/min. His Body Mass Index is 29 kg/m². Examination of the heart, chest, and abdomen are unremarkable. His lower extremity pulses are 2+ with good upstroke.
The patient's laboratory data obtained at the health fair showed a normal complete blood count. His total cholesterol was 240 mg/dL, low density lipoprotein 140 mg/dL, and high density lipoprotein 40 mg/dL. His serum creatinine was 1.3 mg/dL, and the remainder of his laboratory tests were normal. The abdominal ultrasound report revealed an infrarenal abdominal aortic aneurysm with a diameter of 4.2 centimeters.
In addition to addressing the patient's abnormal lipids and blood pressure, which of the following represents the best option at present?

Question

Quizplus · Accepted Answer

This patient has risk factors for an abdominal aortic aneurysm (AAA) including male gender, age over 65, and significant smoking history. USPSTF recommends one-time screening for AAA with ultrasonography in men ages 65 to 75 with a smoking history. The table below shows the risk of rupture based on aneurysm size (strongest predictor). 11ec193a_9731_7103_853d_d570a0d25204_MD0002_00 The 30-day mortality ranges from 1-2% for endovascular surgical repair and 4-5% for open surgical repair of AAA. Since this is equal to the annual rupture risk of AAA < 5.5 cm, surgery is recommended for AAA > 5.5 cm or an increase in diameter > 0.5 cm in a 6-month period. Surgery is also recommended in symptomatic patients, regardless of the size of the aneurysm. Endovascular repair is being used with increasing frequency for elective treatment of abdominal aortic aneurysms. Prospective studies demonstrate lower acute morbidity and mortality and fewer late interventions with endovascular repair in experienced hands. However, long-term survival appears comparable to open repair. < This individual's aneurysm is considered to be relatively small with a low incidence of spontaneous rupture and does not need referral for repair (Choice C & D). He may have a repeat ultrasound or CT scan in 6 - 12 months to monitor the diameter. (Choice A) With this size of aneurysm, re-measurement in a year is appropriate to determine rate of increase in size. There is no evidence that re-measurement earlier would provide benefit. (Choice E) An abdominal CT scan is nearly 100% diagnostic for an abdominal aortic aneurysm and can be used for serial monitoring in this patient in 6 - 12 months. An abdominal CT scan may be indicated prior to elective repair to aid in surgical planning and also if there is suspected leak or rupture. It is not indicated at this time due to recent abdominal ultrasonography. Educational objective: USPSTF recommends one-time screening for AAA with ultrasonography in men ages 65 to 75 with a smoking history. Surgical repair is indicated for AAA > 5.5 cm in diameter or an increase in diameter > 0.5 cm in a 6-month period and in all symptomatic patients. __________ References: Endovascular vs open repair of abdominal aortic aneurysm in the Medicare population (http://www.ncbi.nlm.nih.gov/pubmed/18234751) Endovascular versus open repair of abdominal aortic aneurysm (http://www.ncbi.nlm.nih.gov/pubmed/20382983)

A 67-Year-Old Male Seeks Follow-Up After a Screening Ultrasound at a Health