What is the recommendation for abdominal aortic aneurysm (AAA) screening in individuals aged 65 to 75 who have a history of smoking (tobacco use)?

From the Guidelines

Men aged 65 to 75 who have ever smoked should undergo a one-time abdominal aortic aneurysm (AAA) screening using ultrasonography, as recommended by the American Heart Association/American College of Cardiology joint committee on clinical practice guidelines 1 and the European Society of Cardiology 1. This screening is recommended to detect asymptomatic AAAs, which can help prevent rupture and associated mortality.

Key Points

• The U.S. Preventive Services Task Force (USPSTF) also recommends one-time screening for AAA by ultrasonography in men aged 65 to 75 years who have ever smoked, with a grade B recommendation 1.
• Women in this age group who have ever smoked and have additional risk factors, such as a family history of AAA or other cardiovascular diseases, may also be considered for screening, although the evidence is less clear-cut for this population 1.
• The screening should be performed by a qualified healthcare professional, and if an AAA is detected, further evaluation and management should be individualized based on the size of the aneurysm and other patient factors.

Benefits and Risks

• The benefits of screening for AAA in men aged 65 to 75 years who have ever smoked outweigh the harms, including the potential for decreased AAA-specific mortality 1.
• However, there is also good evidence of important harms of screening and early treatment, including an increased number of surgeries with associated clinically significant morbidity and mortality, and short-term psychological harms 1.
• The USPSTF makes no recommendation for or against screening for AAA in men aged 65 to 75 years who have never smoked, due to the lower prevalence of large AAAs in this population and the potential for harm from screening and treatment 1.

From the Research

Abdominal Aortic Aneurysm (AAA) Screening Recommendations

• The U.S. Preventive Services Task Force recommends one-time screening with ultrasonography for men aged 65 to 75 years who have a history of smoking 2, 3, 4, 5.
• Men in this age group without a history of smoking may benefit from screening if they have other risk factors, such as a family history of abdominal aortic aneurysm, other vascular aneurysms, or coronary artery disease 2.
• There is inconclusive evidence to recommend screening for abdominal aortic aneurysm in women aged 65 to 75 years with a smoking history 2, 6.
• Women without a smoking history should not undergo screening because the harms likely outweigh the benefits 2.

Rationale for Screening Recommendations

• Abdominal aortic aneurysm is a pathologic condition with progressive abdominal aortic dilatation of 3.0 cm or more that predisposes the abdominal aorta to rupture 3.
• The risk factors for abdominal aortic aneurysm include hypertension, coronary artery disease, tobacco use, male sex, a family history of abdominal aortic aneurysm, age older than 65 years, and peripheral artery disease 2, 3, 5.
• Abdominal ultrasonography is the preferred modality to screen for abdominal aortic aneurysm because of its cost-effectiveness and lack of exposure to ionizing radiation 3, 5.

Management of Abdominal Aortic Aneurysm

• Management options for patients with an asymptomatic AAA include reduction of risk factors, medical therapy, watchful waiting, endovascular stenting, and surgical repair depending on the size and expansion rate of the aneurysm and underlying comorbidities 5.
• Surgical intervention by open or endovascular repair is the primary option and is typically reserved for aneurysms 5.5 cm in diameter or greater 2, 3.