What are the guidelines for early abdominal aortic aneurysm (AAA) screening?

From the Guidelines

Early abdominal aortic aneurysm (AAA) screening is recommended as a one-time ultrasound for men aged 65-75 who have ever smoked, and can be considered for men in the same age range who have never smoked, as well as for women who are first-degree relatives of patients with AAA or have ever smoked, according to the most recent guidelines 1. The screening guidelines are based on the latest evidence from the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases, which emphasizes the importance of screening in reducing rupture-related mortality in populations with high AAA prevalence, especially male smokers aged ≥65 years 1. Key points to consider for AAA screening include:

• Men aged 65-75 who have ever smoked should undergo a one-time AAA screening using ultrasound, as recommended by the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1.
• Women who are first-degree relatives of patients with AAA or have ever smoked may also benefit from screening, although the evidence is less clear-cut for this group 1.
• The screening process involves a simple, painless ultrasound examination 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, with aneurysms less than 3.0 cm typically requiring no follow-up, those 3.0-3.9 cm needing ultrasound surveillance every 2-3 years, aneurysms 4.0-4.9 cm being monitored every 6-12 months, and those 5.0 cm or larger generally warranting referral to a vascular surgeon for consideration of repair. These recommendations prioritize reducing AAA-related mortality and morbidity, particularly in at-risk populations, and are supported by evidence from recent studies, including the 2022 ACC/AHA guideline 1 and the 2024 ESC guidelines 1.

From the Research

Guidelines for Early Abdominal Aortic Aneurysm (AAA) Screening

• The US Preventive Services Task Force (USPSTF) recommends one-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked 2.
• The USPSTF 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 2.
• The USPSTF recommends against routine screening for AAA with ultrasonography in women who have never smoked and have no family history of AAA 2.
• 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.

Benefits of Statin Therapy in AAA

• Statin therapy may decrease the progress of AAA and the risk of rupture by suppressing inflammatory mediators, decreasing oxidative stress, and inhibiting mechanisms involved in extracellular matrix degradation 3.
• Statin therapy is likely effective in preventing the growth of small AAAs, and may be more beneficial as the baseline diameter increases 4.
• Statin therapy can reduce the risks of AAA growth rates and mortality, including short-term and long-term mortality after AAA repair 5.

Considerations for Screening and Treatment

• Most AAAs are asymptomatic until they rupture, and the associated risk for death with rupture is as high as 81% 2.
• The current prevalence of AAA in the United States is unclear due to low uptake of screening 2.
• Postoperative statin treatment markedly improves long-term survival, but preoperative statin treatment has no benefit regarding 90-day perioperative survival 6.