From the Guidelines
The most recent and highest quality study recommends one-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked, as stated in the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1. This recommendation is based on evidence that screening reduces AAA-related mortality in men who have smoked. The guidelines also suggest that screening may be considered in men aged ≥75 years (irrespective of smoking history) or in women aged ≥75 years who are current smokers, hypertensive, or both, as well as in first-degree relatives of patients with AAA aged ≥50 years 1. Some key points to consider when screening for AAA include:
- The U.S. Preventive Services Task Force recommends one-time screening for AAA with ultrasonography in men 65 to 75 years of age, who have ever smoked 1.
- Ultrasonography is the most widely used screening and surveillance imaging method for the evaluation of AAA, with sensitivity and specificity close to 100% and a high accuracy comparable to CT, MRI, or MRA 1.
- If an aneurysm is detected, follow-up intervals depend on the size, with surveillance ultrasound recommended every 2-3 years for aneurysms 3.0-3.9 cm, every 6-12 months for 4.0-4.9 cm, and every 3-6 months for 5.0-5.4 cm, and aneurysms 5.5 cm or larger generally warrant referral for surgical consultation 1. It is essential to prioritize the most recent and highest quality study when making recommendations, and in this case, the 2024 ESC guidelines provide the most up-to-date guidance on screening for AAA 1.
From the Research
Guidelines for Screening for Abdominal Aortic Aneurysm (AAA)
The guidelines for screening for AAA are as follows:
- The United States 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.
- 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 3.
- Screening can begin in men older than 65 years of age and does not need to be repeated if results are negative 4.
- An AAA larger than 5.5 cm in diameter should be considered for elective open or endovascular repair 4, 5.
Key Factors to Consider
- Age: Men aged 65 to 75 years are at higher risk for AAA 4, 3, 2.
- Smoking history: Men who have ever smoked are at higher risk for AAA 4, 3, 2.
- Family history: Women with a family history of AAA may be at higher risk, but the evidence is insufficient to determine the net benefit of screening in this group 2.
- Aneurysm size: AAAs larger than 5.5 cm in diameter are at higher risk for rupture and should be considered for elective repair 4, 5.
Benefits and Harms of Screening
- Screening for AAA can reduce mortality from AAA in men aged 65 to 75 years who have ever smoked 4, 5, 2.
- The harms of screening include unnecessary surgery and complications from surgery 5, 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.