Jason Crowner

Limited adoption of abdominal aortic aneurysm screening guidelines associated with no improvement in aneurysm rupture rate

Background: Screening for abdominal aortic aneurysms can prevent life‐threatening rupture. The Screening Abdominal Aortic Aneurysms Very Efficiently Act was implemented in 2007. This provides for a one‐time abdominal aortic aneurysm screening. We hypothesize that the Screening Abdominal Aortic Aneurysms Very Efficiently Act has increased the screening rate and identified more abdominal aortic aneurysms, leading to fewer ruptured abdominal aortic aneurysms. Methods: Centers for Medicare and Medicaid Services data were used to estimate the number of Medicare enrollees eligible for screening and the number screened. The Nationwide Inpatient Sample database was queried for discharges involving abdominal aortic aneurysm rupture and/or repair from the years 2000 to 2015 to assess national trends in abdominal aortic aneurysm admissions. The main outcomes were abdominal aortic aneurysm screening rates and standardized yearly incidence of abdominal aortic aneurysm rupture and abdominal aortic aneurysm repairs (stratified by open and endovascular). Results: The number of patients screened increased from 9,884 (2007) to 95,243 (2015). The screening rate increased from 0.2% (2007) to 1.4% (2015) (P < .001) of eligible patients. The number of abdominal aortic aneurysm ruptures increased slightly after the initiation of the Screening Abdominal Aortic Aneurysms Very Efficiently Act from 8.3 per 100,000 to 9.4 per 100,000 (incidence rate ratio 1.12, 95% confidence interval 1.06–1.19). The average yearly change in abdominal aortic aneurysm ruptures was not significant (95% confidence interval –0.01 to 0.00, P=.30). The number of open abdominal aortic aneurysm repairs declined, while endovascular repairs increased during the study period. Conclusion: The Screening Abdominal Aortic Aneurysms Very Efficiently Act has increased the number of patients being screened; however, screening rates remain low. The number of patients presenting with rupture has not decreased. Screening strategies need to be reassessed or made more widely available for this legislation to have an impact.

Vascular Surgery Training: Multiple Pathways to Success

Much like in other surgical specialties, vascular surgery has more than one pathway to success. Alternate training pathways allow for individuals to choose which might be best for them and allow them to optimally accomplish their career goals. This chapter highlights the various vascular surgery programs and the pros and cons of each.