|7. Monitoring of AAA|
|Monitoring of asymptomatic AAA between 4.0 and 5.4 cm in diameter|
|Numerator||Patients whose AAA diameter was measured at least once within the last year.|
|Denominator||All patients age ≥18 y and over with asymptomatic abdominal aortic aneurysm between 4.0 and 5.4 cm at the start of the measurement period.|
■ Patients with known symptomatic AAA
■ Patients with AAA diameter <4.0 cm or ≥5.5 cm
■ Patients who have had elective repair of their AAA
■ Medical reason(s) documented by a physician, advanced practice nurse, or physician assistant, for not measuring AAA diameter, for example: Patients who are not candidates for AAA repair of any type due to comorbidities or surgical risk (e.g., metastatic cancer, dementia, severe cardiopulmonary disease).
■ Documented patient reason(s) for not measuring AAA diameter (e.g., patient refusal).
|Period of Assessment||1-y measurement period|
|Sources of Data||Electronic medical records, retrospective paper records, and prospective flow sheets|
|Aneurysm size remains the single most important predictor not only for aneurysm rupture but also for death from other cardiovascular events. Prospective studies have indicated that small aneurysms (<5.5 cm) have a low risk of rupture and may be safely monitored with annual or semiannual imaging.|
|ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (12)|
1. Patients with infrarenal or juxtarenal AAAs measuring 5.5 cm or larger should undergo repair to eliminate the risk of rupture. (Level of Evidence: B)
2. Patients with infrarenal or juxtarenal AAAs measuring 4.0 to 5.4 cm should be monitored by ultrasound, computerized tomography imaging, or magnetic resonance every 6 to 12 months to detect expansion. (Level of Evidence: A)
|This measure should be reported by all clinicians and/or practices managing patients with cardiovascular disease. The level of “aggregation” (clinician versus practice) will depend upon the availability of adequate sample sizes to provide stable estimates of performance.|
|Method of Reporting|
Whether the patient's abdominal aortic aneurysm diameter was measured.
Per patient population:
Percentage of patients whose abdominal aortic aneurysm diameter was measured.
|Challenges to Implementation|
|Sample size may preclude reporting of reliable performance estimates, particularly at the clinician level.|
AAA indicates abdominal aortic aneurysms.