Obligatory medical device diagnostics.
- Abdominal ultrasonography (ultrasound examination of abdominal organs; with ultrasound contrast agent, if necessary) – if abdominal aortic aneurysm (AAA) is suspected [ultrasound screening for abdominal aortic aneurysms].
- Computed tomography (CT) of the abdomen (abdominal CT) – when abdominal aortic aneurysm is suspected or to show the morphology of an aneurysm.
- Note (S3 guideline]: CTA should be used as the method of choice for preprocedural imaging diagnosis of AAA. Evidence level 3a/Recommendation level A.
Notice:
- An AAA is present when the arterial wall of the infrarenal or suprarenal aorta is >30 mm, which is 150% of the “normal” vessel diameter.
- Vascular surgical evaluation should be performed at the latest when the arterial wall diameter is 4.5 cm; vascular surgical evaluation should begin earlier in cases of rapid growth (> 3 mm per six months) and asymmetric morphology.
Further notes
- For the diagnosis of abdominal aortic aneurysm (AAA) (abdominal aortic aneurysm, BAA), the maximum vessel diameter is critical. The diameter is determined in the plane perpendicular to the blood flow. Sonography must cover the complete vascular axis.
- The examination must be repeated every 3-6 months (watch and wait).
- Surgical therapy: 5.0-5.5 cm (men); > 4.5 cm (women).
- IQWiG (Institute for Quality and Efficiency in Health Care) recommends a one-time “ultrasound screening for abdominal aortic aneurysms” for men aged 65 years and older. The prevalence (disease incidence) of AAA is 1.5% annually. The mortality (death rate) of ruptured abdominal aortic aneurysm is high, up to 80%.
- Ultrasound screening for early detection of abdominal aortic aneurysms (AAA) is available to men aged 65 years and older with statutory health insurance as of January 1, 2018.Screening the population for AAA with ultrasound [as recommended by the S3 guideline].
- Should be recommended for all men >65 years of age. (Evidence grade 1a/Recommendation grade A).
- Shall be recommended to women > 65 years of age with a current or past smoking history. (Level of evidence 2a, recommendation grade A).
- Should not be recommended to nonsmoking women with no family history of smoking. (Level of evidence 2a/grade of recommendation B).
- Should be considered in 1st-degree siblings of a patient with AAA. (Level of evidence 2c/grade of recommendation B).
