From the Guidelines
Men aged 65-75 who have ever smoked should be screened for abdominal aortic aneurysm (AAA) as they have the highest risk of developing this potentially life-threatening condition, according to the most recent and highest quality study 1. This recommendation is based on the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease, which suggests that ultrasound screening for detection of AAA is recommended in men who are ≥65 years of age who have ever smoked. The rationale for this recommendation is that AAAs are often asymptomatic until they rupture, which carries a high mortality rate. Early detection through ultrasound screening, which is non-invasive and highly accurate, allows for monitoring of small aneurysms or timely surgical intervention for larger ones, significantly reducing rupture risk and improving survival rates. Some key points to consider when deciding who to screen for AAA include:
- Men aged 65-75 who have never smoked may also be screened, though the benefit is less clear 1
- Women who are ≥65 years of age and who are first-degree relatives of patients with AAA may benefit from screening 1
- Women who are ≥65 years of age who have ever smoked may also benefit from screening, although the evidence is not as strong as for men 1 It's essential to weigh the benefits and harms of screening, considering the potential for reduced AAA-specific mortality against the risks of increased surgeries and associated morbidity and mortality, as well as short-term psychological harms. The most recent and highest quality study 1 provides the best evidence for guiding clinical practice in this area.
From the Research
Screening for Abdominal Aortic Aneurysm (AAA)
The following individuals should be screened for AAA:
- Men aged 65 to 75 years who have ever smoked, as recommended by the USPSTF with moderate certainty that screening is of moderate net benefit 2
- Men aged 65 to 75 years who have never smoked, with the USPSTF recommending that clinicians selectively offer screening rather than routinely screening all men in this group 2
Individuals Who Should Not Be Screened
- Women who have never smoked and have no family history of AAA, as the USPSTF recommends against routine screening in this group 2
Uncertain Recommendations
- The USPSTF concludes that the evidence is insufficient to determine the net benefit of screening for AAA in women aged 65 to 75 years who have ever smoked or have a family history of AAA 2
Risk Factors
- Age older than 60 years
- Smoking
- Hypertension
- Caucasian ethnicity, as these factors increase the risk of AAA 3