Good evening. Thanks for having me to um speak here and thanks everyone for coming. Um So I'll just be briefly and basically discussing what to do with the patient um who has a positive screening duplex for triple A. So the us preventive services task force recommends that male patients between 65 and 70 75 years of age who have ever smoked um receive a Triple A. Screening duplex. So it's important to keep in mind when you're seeing your patients um in the primary care setting or um you know not in the vascular clinic, you may not be thinking about Triple A. But anyone who has a smoking history even if they've quit um they should be screened for Triple A. There's lower grade evidence that suggests that male or female patients over 65 who have a first degree relative where the TRIPLE A. Should be screened. Um They're simply you have find a lot of our guidelines have recommendations for male patients. Um And that is basically because there's not enough studies that included enough women to make higher grade recommendations. But um a lot of these at least in my practice it's um based on your experience and there is some um room for you to make your own clinical judgment about who to screen. So um if there's a first degree relative diagnosed with Triple A. Or selectively which is you know your opinion based on medical and family history. Um It's an easy test. Um And uh you know it's easy on the patient noninvasive, so I'm pretty liberal about ordering them if I'm worried uh important to note that duplex for any purpose is operator dependent. So it's a useful test for screening um And also useful for following known triple A. S. So we don't have to get a ct scan uh You know routinely for someone who have small who has a small aneurism. Um But it can be very operator and patient dependent. So it will be limited in patients who are obese. Um If the patient has eaten before then they may have a lot of bowel gas. You may not get good images. Um So important to note that you know keep in mind that the size of the aneurysm may vary somewhat. Study from one study to the next without a change in the true aortic diameter. So um for small aneurysms it's safe to follow the you know followed by duplex and accept that margin of error. But once you reach a larger size you really need to have a ct scan to get a true measurement. So when you have a patient in your clinic who who had a positive duplex um and you go to do a physical examination most often there there are not many specific findings, especially in larger patients but you should do a full vascular examination. Um feel their pop little faucet for pop little aneurysms which can be associated in thin patients or patients with larger aneurysms. You may feel a palpable pulse, it'll mass in the abdomen which is usually just above the umbilicus. Um If that pulse it'll mass is tender. Then that patient needs to go to the er um and have a vascular surgery consult. So for triple A. Size matters if the patient so Aorta greater than three cm is typically typically considered aneurysm all So anything less than four cm you can safely continue yearly duplex surveillance and an easy rule of thumb is greater than four is just send it to vascular surgery. We're happy to take these patients and take over their monitoring. But even at At four cm we would continue monitoring these by Duplex. If you're worried or unsure just send them to us. We're happy to take on these patients. Even at a small aneurysm size. Any patient who has a symptom such as new or worsening back or abdominal pain needs an urgent referral to the er and a vascular surgery consult in the context of a positive triple A duplex. The most important thing in the um you know outside of the vascular surgery clinic. Although we do get involved in this heavily as well is when you see a patient with a positive triple A duplex. Usually that is not the problem that's going to and their life most likely it's going to be a other cardiovascular risk factors. Such a stroke or am I. So the most important thing when you find someone with a triple A. On duplexes to manage their cardiovascular risk factors encourage them to stop smoking. Put them on statin therapy, put them on aspirin therapy and manage their hypertension. So it should be a trigger to um look for other vascular issues. That's all. Thank you.