Risk Focused Screening for Vascular Disease: One University Hospital's Experience

Abstract

Introduction

Vascular screening programs have been gaining popularity in recent years; however, most programs accept all patients willing to participate. This study was designed to determine the yield of disease when screening examinations are limited to those most at risk, to stratify the amount of disease present in the at-risk population, and to establish which patients might benefit most from vascular screening.

Materials and Methods

Patients enrolled in a community outreach program for seniors 55 years of age and older were asked to participate in a free vascular screening. Screenings consisted of completion of a questionnaire, physical examination, limited carotid artery evaluation for stenosis, aorta evaluation for detection of aneurysm, and ankle/brachial index (ABI) calculation to detect peripheral vascular disease. Findings were grouped into “Normal,” “Mild disease,” and “Significant disease.” Findings were then compared with the following controllable risk factors: hypertension, hyperlipidemia, diabetes, coronary artery disease (CAD), or smoking history.

Results

Between May 16 and October 17, 2007, 357 participants' (75 male, 157 female, mean age 72.9 years) results were analyzed. Overall, 140 participants (43%) had some form of vascular disease (“mild” and “significant” categories combined). Of 324 eligible participants, carotid findings showed 199 normal (61%), 104 mild (32%), and 21 significant (7%) results. Aorta findings showed 296 normal (91%), 25 mild (8%), and 3 significant (1%) results. ABI findings showed 278 normal (86%), 18 mild (6%), and 28 significant (8%) results. In participants with three or more risk factors, there was a greater probability that carotid (p = 0.0022) and peripheral vascular disease (p = 0.0003) would be detected; however, there was no predictive value for aortic aneurysm (p = 0.5).

Conclusion

Vascular screening programs focusing on the at-risk population may reduce unnecessary testing compared with programs evaluating all patients willing to participate.

Get full access to this article

View all access options for this article.

References

U.S. Preventive Services Task Force. Screening for Abdominal Aortic Aneurysm: Recommendation Statement. AHRQ Publication No. 05-0569-A. Rockville, MD: Agency for Healthcare Research and Quality, February 2005. Available at: http://www.ahrq.gov/clinic/uspstf05/aaascr/aaars.htm. Accessed June 28, 2010.

Urffer

Swavely

Lee

Wilson

First-year results of a community peripheral vascular screening program at an academic community hospital. J Vasc Nurs 2006; 24: 11–14.

Lacroix

Aboyans

Criqui

M.H.

Type-2 diabetes and carotid stenosis: A proposal for a screening strategy in asymptomatic patients. Vasc Med 2006; 11: 93–99.

Rancic

Radak

Stojanovic

Early detection of asymptomatic carotid disease in patients with obliterative arteriosclerosis of the lower extremities. Srp Arh Celok Lek 2002; 130: 258–264.

Marek

Mills

J.L.

Harvich

Utility of routine carotid duplex screening in patients who have claudication. J Vasc Surg 1996; 4: 572–577.

Jacobowitz

G.R.

Rockman

C.B.

Gagne

P.J.

A model for predicting occult carotid artery stenosis: Screening is justified in a selected population. J Vasc Surg 2003; 38: 705–709.

U.S. Preventive Services Task Force. Screening for Carotid Artery Stenosis: U.S. Preventive Services Task Force Recommendation Statement. AHRQ Publication No. 08-05102-EF-2. First published in Ann Intern Med 2007; 147: 854–859. Rockville, MD: Agency for Healthcare Research and Quality, December 2007. Available at: http://www.ahrq.gov/clinic/uspstf07/cas/casrs.htm. Accessed June 28, 2010.

U.S. Preventive Services Task Force. Screening for Peripheral Arterial Disease: Recommendation Statement. AHRQ Publication No. 05-0583-A-EF. Rockville, MD: Agency for Healthcare Research and Quality, August 2005. Available at: http://www.ahrq.gov/clinic/uspstf05/pad/padrs.htm. Accessed June 28, 2010.

American Heart Association. Heart Disease and Stroke Statistics- 2005 Update. Dallas, TX: Author; 2005.

10.

U.S. Department of Health and Human Services. Morbidity & Mortality: 2004 Chart Book on Cardiovascular, Lung and Blood Diseases. Washington, DC: Author; 2004.

11.

Graham

G.D.

Secondary stroke prevention: From guidelines to clinical practice. J Natl Med Assoc 2008; 100: 1125–1137.

12.

Kasper

G.C.

Lohr

J.M.

Welling

R.E.

Clinical benefit of carotid endarterectomy based on duplex ultrasonography. Vasc Endovascular Surg 2003; 37: 323–327.

13.

Ranger

W.R.

Glover

J.L.

Bendick

P.J.

Carotid endarterectomy based on preoperative duplex ultrasound. Am Surg 1995; 61: 548–554, discussion 554–555.

14.

Logason

Karacagil

Hårdemark

H.G.

Boström

Hellberg

Ljungman

Carotid artery endarterectomy solely based on duplex scan findings. Vasc Endovascular Surg 2002; 36: 9–15.

15.

Buskens

Nederkoorn

P.J.

Buijs-Van Der Woude

Imaging of carotid arteries in symptomatic patients: Cost-effectiveness of diagnostic strategies. Radiology 2004; 233: 101–112. Epub 2004 Aug 27.

16.

Brown

O.W.

Bendick

P.J.

Bove

P.G.

Reliability of extracranial carotid artery duplex ultrasound scanning: Value of vascular laboratory accreditation. J Vasc Surg 2004; 39: 366–371.

17.

Thusay

M.M.

Khoury

Greene

Carotid endarterectomy based on duplex ultrasound in patients with and without hemispheric symptoms. Am Surg 2001; 67: 1–6.

18.

Beckman

J.A.

Jaff

M.R.

Creager

M.A.

The United States preventive services task force recommendation statement on screening for peripheral arterial disease: More harm than benefit?

Circulation 2006; 114: 861–866.

19.

Cina

C.S.

Safar

H.A.

Maggisano

Prevalence and progression of internal carotid artery stenosis in patients with peripheral arterial occlusive disease. J Vasc Surg 2002; 36: 75–82.

20.

Rockman

C.B.

Jacobowitz

G.R.

Gagne

P.J.

Focused screening for occult carotid artery disease: Patients with known heart disease are at high risk. J Vasc Surg 2004; 39: 44–51.

21.

Cournot

Boccalon

Cambou

J.P.

Accuracy of the screening physical examination to identify subclinical atehrosclerosis and peripheral arterial disease in asymptomatic subjects. J Vasc Surg 2007; 46: 1215–1221.

22.

Khan

N.A.

Rahim

S.A.

Anand

S.S.

Does the clinical examination predict lower extremity peripheral arterial disease?

JAMA 2006; 296: 536–546.

23.

Al-Omran

Knowledge and attitude of physicians in a major teaching hospital towards atherosclerotic risk reduction therapy in patients with peripheral arterial disease. Vasc Health Risk Manag 2007; 3: 1019–1027.

24.

Poredos

Jug

The prevalence of peripheral arterial disease in high risk subjects and coronary or cerebrovascular patients. Angiology 2007; 58: 309–315.