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Dr. Phil O’Halloran

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%

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Dr. Phil O’Halloran

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  1. Dr. Phil O’Halloran • Surgical Grand Rounds

  2. Case. • HS 65 year old male • electively admitted for an EVAR on the. • Pilot Screening programme AAA Size (cm) = 5.62

  3. 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

  4. Post Op • Transfer back to Ward. • Normal bloods day 1 post-op. • Eating and Drinking. • Mobilizing. • Discharged well.

  5. AAA Screening. • Should we be doing it?

  6. AAA Screening NHS Abdominal Aortic Aneurysm Screening Programme

  7. AAA Screening -Why? • 8:1 • 4% of men aged 65-74. • Significant Morbidity & Mortality. • Vascular Disease = 40% of UK deaths. • Family History. • Smoking / Hypertension.

  8. AAA Screening

  9. Lancet 2002; Nov 16; 360 (9345): 1531-9.

  10. MASS Study

  11. MASS Study

  12. 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)

  13. . 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.

  14. 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

  15. 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

  16. 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.

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