腹動脈動脈瘤のスクリーニング:米国予防サービスタスクフォースの勧告声明
, Douglas K Owens1,2, Karina W Davidson3
1Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
JAMA
|December 11, 2019
まとめ
腹動脈動脈瘤 (AAA) のスクリーニングは,これまで喫煙した65~75歳の男性に推奨されます. ルーティンスクリーニングは,家族歴や喫煙歴のない女性には推奨されません.
科学分野:
- 血管 外科
- 予防 医療
- 診断用イメージング
背景:
- 腹部大動脈瘤 (AAA) は,大動脈の膨張≥3. 0cmと定義されています.
- AAAの罹患率は,スクリーニングを受けたヨーロッパ人男性では減少したが,スクリーニングの利用率が低いため,米国では不明である.
- 破裂したAAAは81%の死亡リスクを持ち,ほとんどのAAAは破裂まで無症状である.
研究 の 目的:
- AAAスクリーニングに関する2014年の勧告を更新する.
- 小型AAAのスクリーニングの有効性,有害性,治療効果に関する証拠をレビューする.
主な方法:
- USPSTFが依頼した証拠調査
- AAAの1回および繰り返しスクリーニングに焦点を当てた.
- 小型AAA (3.0~5.4cm) の治療の利益と害を考慮した.
主要な成果:
- 喫煙歴のある65~75歳の男性におけるAAAスクリーニングの純利益
- 喫煙したことがない65~75歳の男性におけるスクリーニングの純利益は小さい.
- 喫煙者または家族歴のある65~75歳の女性のスクリーニングの証拠は不十分です.
結論:
- 喫煙した男性 (65~75歳) の場合,超音波によるAAAスクリーニングを1回行うことを推奨する (B推奨).
- 選択的に65~75歳まで喫煙したことがない男性にスクリーニングを行う (C推奨).
- 喫煙歴のない65歳~75歳の女性には,通常のスクリーニングを推奨しないこと (D推奨).
関連する概念動画
Aortic Regurgitation II: Clinical Features and Diagnostic Tests
1.2K
Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
1.2K
Aortic Regurgitation III: Medical Management
598
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
598
Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
948
Atherosclerosis is a progressive disorder that leads to the thickening and narrowing of arterial walls due to plaque buildup. This condition can cause various symptoms depending on the arteries affected:Coronary Artery Disease (CAD): This condition affects the coronary arteries and may lead to chest pain (angina), shortness of breath (dyspnea), heart attacks, and other heart disease symptoms.Cerebrovascular Disease: This affects blood flow to the brain, causing transient ischemic attacks (TIAs)...
948
Aneurysm I: Introduction
650
An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
650
Aneurysm II: Clinical Manifestations and Diagnostic Studies
589
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
589
Aneurysm III: Interprofessional Care
478
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
478


