Screening for AAA: Clinical Evaluation of a Simple and Cost-effective Handheld Aortic Scanning Device for Use in an Outpatient Vascular Surgery Clinic

Introduction - Ruptured aneurysms of the abdominal aorta (rAAA) account for approximately 1000 deaths in our country each year [1]. Efforts to implement routine screening for selected patients could decrease the rAAA mortality rate. Screening programs for AAA are used in several countries [2], selecting patients based on age, sex, or cardiovascular risk profile. However, screening is costly and typically requires separate hospital visits. We hypothesized that if patients were routinely screened during planned outpatient visits, burden and costs could be greatly reduced. To this end, we evaluated whether a handheld ultrasound aortic screening device could be a useful tool to screen for asymptomatic AAA in our outpatient clinic. Methods - We selected 96 patients diagnosed with peripheral artery disease and who had a waist-hip-circumference (WHC) <115cm. Their abdominal aorta (AP diameter) was measured using a handheld aortic scanning device (AortaScan® BVI 9600, Auxo Medical, Richmond, VA, USA {3}). This group included 44 patients (46%) with an AAA of >3cm. As control, all patients were subjected to a conventional ultrasound of the abdominal aorta. We used SPSS 23.0 to perform statistical analysis of the data and determine specificity, sensitivity, positive and negative predictive value (PPV and NPV, respectively), and Kappa value (strength of agreement between methods). Results - Analysis of our results yielded a sensitivity of 90% and specificity of 98% for the Aortascan as compared to conventional ultrasound. The strength of agreement (Kappa) was 0.88. PPV and NPV were 0.98 and 0.90. Conclusion - Screening programs must balance the costs of screening with clinical benefit. The Aortascan BVI 9600 can lower costs and increase ease of use. We found that this device is reliable in screening for AAA in patients with a WHC <115. These new findings supplement previous reports which postulated that additional research is necessary to determine the suitability of hand-held screening devices for AAA screening [4,5]. References 1. Nelissen et al J. Vasc Surg 2015; 61 (3): 642-647 2. Kim LG et al Ann Intern Med 2007; 146 (10): 699-706 3. http://auxomedical.com/product/verathon-bladderscan-bvi-9600/ 4. Nguyen et al, Eur J Vasc Endovasc Surg 2014; 48 (2):147-52 5. Abbas et al, Eur J Vasc Endovascr Surg. 2012 43 (1): 167-170