From the Guidelines
Screening for aortic aneurysms is primarily recommended for men aged 65 years and older with a history of smoking, using duplex ultrasound (DUS) to reduce the risk of death from ruptured AAA, as stated in the 2024 ESC guidelines 1. The screening protocol for aortic aneurysms involves a one-time ultrasound examination for men who have ever smoked, with selective screening considered for men who have never smoked based on risk factors. Women generally are not recommended for routine screening unless they have significant risk factors such as family history of aortic aneurysm, personal history of smoking, or other vascular conditions.
Key Points:
- The screening test of choice is abdominal ultrasound, which is non-invasive, relatively inexpensive, and has high sensitivity and specificity for detecting abdominal aortic aneurysms.
- For those with a family history of thoracic aortic aneurysms or genetic conditions like Marfan syndrome, CT or MRI imaging of the thoracic aorta may be appropriate.
- If an aneurysm is detected, follow-up intervals depend on size: smaller aneurysms (3-4 cm) typically require monitoring every 2-3 years, medium-sized (4-5 cm) annually, and larger ones (>5 cm) may need more frequent monitoring or consideration for repair, as suggested by the acr appropriateness criteria® screening for abdominal aortic aneurysm 1. Some key considerations for screening include:
- Family history of aortic aneurysm or cardiovascular disease
- Smoking history
- Hypertension
- Hypercholesterolemia
- Peripheral artery disease
- Increasing age
- Genetic syndromes
- Inflammatory diseases Screening is important because aortic aneurysms are often asymptomatic until rupture, which carries a high mortality rate, while early detection allows for monitoring and timely intervention before complications occur, as highlighted in the 2024 esc guidelines for the management of peripheral arterial and aortic diseases 1.
From the Research
Screening Protocol for Aortic Aneurysms
The screening protocol for aortic aneurysms involves the use of abdominal ultrasonography as the primary screening modality due to its high sensitivity and specificity, as well as its safety and relatively lower cost 2. The decision to screen for abdominal aortic aneurysms (AAAs) is based on various risk factors, including:
- Age older than 60 years
- Smoking
- Hypertension
- Caucasian ethnicity
- Family history of AAA
Recommendations for Screening
The United States Preventive Services Task Force recommends that men between the ages of 65 to 75 years who have ever smoked should be screened at least once for AAAs by abdominal ultrasonography 2. Other studies suggest that screening should be expanded to include at-risk individuals not identified with existing screening criteria, such as women, nonsmokers, and individuals aged <65 years 3.
Risk Factors for Abdominal Aortic Aneurysm
Several risk factors have been identified for AAA, including:
- Male sex
- Age >65 years
- Smoking
- Hypertension
- Family history of AAA
- Coronary artery disease
- Caucasian ethnicity
These risk factors can be used to identify individuals who may benefit from screening for AAA 3, 4, 5.
Screening Methods
Abdominal ultrasonography is the most commonly used screening method for AAA due to its high sensitivity and specificity 2, 4. Other imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), may also be used to diagnose and monitor AAA 4.
Importance of Screening
Screening for AAA is important for public health, as it can help avoid deaths, ruptures, and emergency surgical interventions if AAA is diagnosed early in the population target for screening 5.