From the Guidelines
Screening for abdominal aortic aneurysm (AAA) is recommended as a one-time ultrasound for men aged 65-75 who have ever smoked, as this population has the highest risk-benefit ratio for detection and intervention. For men aged 65-75 who have never smoked, selective screening may be considered based on individual risk factors. Screening is generally not recommended for women, except potentially for those with a strong family history of AAA or multiple risk factors. The screening process involves a simple, non-invasive abdominal ultrasound that takes about 10-15 minutes to complete and does not require any special preparation. If an AAA is detected, management depends on its size: small aneurysms (3.0-3.9 cm) typically require monitoring with repeat ultrasounds every 2-3 years, medium aneurysms (4.0-5.4 cm) need more frequent monitoring every 6-12 months, and large aneurysms (≥5.5 cm) generally warrant referral for surgical consultation. These recommendations are based on evidence showing that AAA screening in appropriate populations reduces aneurysm-related mortality by enabling early detection and timely intervention before rupture occurs, which carries a high mortality rate of 80-90% 1.
Key Points
- The U.S. Preventive Services Task Force recommends one-time screening for AAA by ultrasonography in men aged 65 to 75 years who have ever smoked 1.
- Abdominal ultrasonography is an accurate screening test for AAA, with sensitivity and specificity close to 100% 1.
- The screening process is simple, non-invasive, and does not require special preparation.
- Management of detected AAA depends on its size, with small aneurysms requiring monitoring, medium aneurysms requiring more frequent monitoring, and large aneurysms warranting referral for surgical consultation.
Recommendations
- Men aged 65-75 who have ever smoked should undergo one-time AAA screening.
- Men aged 65-75 who have never smoked may be considered for selective screening based on individual risk factors.
- Women with a strong family history of AAA or multiple risk factors may be considered for screening.
- AAA screening should be performed using abdominal ultrasonography.
From the Research
Abdominal Aortic Aneurysm Screening Recommendations
- The United States Preventive Services Task Force recommends that men between the age of 65 to 75 years who have ever smoked should be screened at least once for abdominal aortic aneurysms (AAAs) by abdominal ultrasonography 2, 3, 4.
- The USPSTF also recommends that clinicians selectively offer screening for AAA with ultrasonography in men aged 65 to 75 years who have never smoked rather than routinely screening all men in this group 4.
- For women, the USPSTF recommends against routine screening for AAA with ultrasonography in women who have never smoked and have no family history of AAA 4.
- 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 4.
Screening Modality
- Abdominal ultrasonography is considered the screening modality of choice for detecting AAAs because of its high sensitivity and specificity, as well as its safety and relatively lower cost 2, 3, 5.
- Modern functional imaging techniques (PET, CT, and MRI) may help to assess rupture risk 6.
Risk Factors
- 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, 6, 3.
- The likelihood that an aneurysm will rupture is influenced by the aneurysm size, expansion rate, continued smoking, and persistent hypertension 2.
Management Options
- Management options for patients with an asymptomatic AAA include reduction of risk factors such as smoking, hypertension, and dyslipidemia; medical therapy with beta-blockers; watchful waiting; endovascular stenting; and surgical repair depending on the size and expansion rate of the aneurysm and underlying comorbidities 2, 3.