What are the screening guidelines for abdominal aortic aneurysm (AAA) in individuals with a family history of AAA?

From the Guidelines

Individuals with a family history of abdominal aortic aneurysm (AAA) should undergo ultrasound screening for detection of AAA at age 65, as recommended by the 2022 ACC/AHA guideline 1. The screening guidelines for abdominal aortic aneurysm (AAA) in individuals with a family history of AAA are based on the latest evidence from the 2022 ACC/AHA guideline 1.

Key Recommendations

• Ultrasound screening for detection of AAA is recommended in men or women who are ≥65 years of age and who are first-degree relatives of patients with AAA 1.
• The growth of AAA is nonlinear, with a mean rate of 2.6 mm/y for AAA <5.0 cm, and may accelerate in the setting of smoking or a family history of AAA 1.
• Family history is a significant risk factor for AAA development, with first-degree relatives having approximately a 10-25% higher risk compared to the general population 1.

Screening and Follow-up

• If the initial screening is normal, no further routine screening is typically needed, except in cases where the individual has multiple risk factors or a first-degree relative with AAA 1.
• If an aneurysm is detected, follow-up imaging should be scheduled based on the size of the aneurysm, with more frequent imaging for larger aneurysms 1.
• Aneurysms 5.5 cm or larger generally warrant referral for surgical consultation 1.

Risk Factor Management

• Patients with family history should be counseled on modifiable risk factors, particularly smoking cessation, as smoking significantly accelerates AAA growth and increases rupture risk 1.
• Blood pressure control is also important in managing risk in these patients 1.

From the Research

Screening Guidelines for Abdominal Aortic Aneurysm (AAA) with Family History

• The U.S. Preventive Services Task Force recommends one-time abdominal aortic aneurysm screening with ultrasonography for men with a history of smoking who are 65 to 75 years of age 2.
• The Screening Abdominal Aortic Aneurysms Efficiently (SAAAVE) Act provides coverage for a one-time screening abdominal ultrasound at age 65 for men who have smoked at least 100 cigarettes and women who have a family history of AAA disease 3.
• Individuals with a family history of AAA are at increased risk, with an estimated 11.6-fold increase in AAA risk among persons with an affected first-degree relative 4.
• Abdominal ultrasonography is the preferred modality to screen for abdominal aortic aneurysm due to its cost-effectiveness and lack of exposure to ionizing radiation 2.

Risk Factors and Screening

• Risk factors for the development of AAA include age > 60, tobacco use, male gender, Caucasian race, and family history of AAA 3, 5.
• AAA is most common in men > 65 years of age, and the risk of rupture increases with diameter 5.
• Screening programs with ultrasonography can help detect AAA early, and elective repair of AAA with open surgery or endovascular aortic repair (EVAR) can prevent AAA rupture 5, 6.

Management and Surveillance

• Medical management is recommended for asymptomatic patients with AAAs < 5 cm in diameter and focuses on modifiable risk factors, including smoking cessation and blood pressure control 3.
• Surgical management is indicated when the aneurysm diameter is 5.5 cm or larger in men and 5.0 cm or larger in women 2.
• Surveillance of abdominal aortic aneurysm depends on the size and growth rate of the aneurysm, and the most serious complication of abdominal aortic aneurysm is rupture, which requires emergent surgical intervention 2.