Cath Lab Digest

The EPics 1 study reported by Dall’Olmo et al,¹ in this issue of Vascular Disease Management reports on one surgical group’s evaluation of patients age 60 and older, both male and female, with a history of surgical, coronary revascularization invited to participate in an abdominal aortic aneurysm (AAA) screening program. The authors identified aneurysms in 9% of males screened and 5% of females screened with the majority of these in both groups having been previously unrecognized. This study is important in that it confirms the presence of increased risk for the presence of AAA in a defined population with clinically significant coronary disease, and notes the presence of this problem in males and females.

The recently implemented SAAAVE Act (Screening Abdominal Aortic Aneurysms Very Efficiently Act, a provision of S. 1932, the Deficit Reduction Act of 2005) allows a one time ultrasound screening benefit to check for AAA in Medicare beneficiaries who are “at risk”. The population defined as being at risk includes men who have at least a 100-pack year smoking history and men and women with a family history of AAA. While we applaud this Act for subsidizing screening of patients at risk for AAA, there are clearly other groups of patients who are at high risk that are not addressed with this coverage. Additionally, large, population-based trials that have implemented screening among the elderly without regard to “risk” have clearly shown benefit in reducing aneurysm related deaths among screening participants.^2,3

In assessing patients with coronary artery disease (CAD), the authors of the current study have identified a high-risk group of patients who clearly would benefit from screening. This increased risk affects both males and females with a history of CAD who have undergone surgical revascularization. Understanding the propensity for atherosclerosis to have systemic effects upon those afflicted, it would appear likely that atherosclerotic disease in other vascular beds would put patients at increased risk for the development of abdominal aortic aneurysm as well. Screening studies such as these are to be applauded as they provide additional data to physicians and legislators alike regarding the need to expand coverage for AAA screening in the Medicare population.

We look forward to more information regarding these increased risk groups to provide evidence for expansion of this coverage.