Recommended Age for Abdominal Aortic Aneurysm (AAA) Screening
Men ages 65 to 75 who smoke or have ever smoked should have a one-time AAA screening with ultrasonography, while screening should be selectively offered to men in the same age range who have never smoked. 1, 2
Screening Recommendations by Population Group
Men
- Men ages 65 to 75 who have ever smoked (defined as smoking at least 100 cigarettes in their lifetime) should receive a one-time screening for AAA with ultrasonography (Grade B recommendation) 1, 2
- Men ages 65 to 75 who have never smoked may be selectively offered screening rather than routinely screening all men in this group (Grade C recommendation) 1
- The prevalence of large AAAs is lower in men who have never smoked compared to those who have ever smoked, resulting in smaller potential benefit from screening 1
Women
- Women who have never smoked should not receive routine AAA screening as the harms outweigh the benefits (Grade D recommendation) 1, 2
- For women ages 65 to 75 who have ever smoked or have a family history of AAA, there is insufficient evidence to make a recommendation for or against screening (I statement) 3, 2
- AAA is rare in women who have never smoked 1
Risk Factors for AAA
- Age older than 65 years 4, 5
- Male sex 4, 6
- Smoking history (current smoking carries highest risk with OR 3.28) 6, 5
- Family history of AAA (OR 1.60) 6
- Cardiac disease 6
- Hypertension 5
- Caucasian ethnicity 5
Screening Method and Follow-up
- AAA screening is performed using abdominal ultrasonography, which is safe, painless, and has high sensitivity and specificity 1, 5
- Ultrasonography should be performed in an accredited facility with credentialed technologists to ensure adequate quality assurance 1
- For small aneurysms (less than 5.5 cm in diameter), periodic monitoring with ultrasound is typically recommended 1, 4
- Surgical intervention is generally recommended for aneurysms 5.5 cm or larger, or those growing rapidly 1, 4
Special Considerations
- Current smokers have the highest risk of AAA (OR 6.33 for females and OR 2.50 for males) 6
- Male smokers aged 55-64 years have a prevalence of 4.43%, suggesting potential benefit from earlier screening in high-risk individuals 6
- Female ever-smokers aged 65-75 years have a prevalence of 1.7% 6
- Morbidly obese females have significantly increased risk (OR 5.54-5.61) 6
Potential Pitfalls and Caveats
- Despite recommendations, AAA screening may be underutilized in the target population 7
- Overly broad application of screening beyond recommended groups may reduce the effectiveness and cost-effectiveness of AAA screening programs 7
- Most AAAs are asymptomatic until rupture, with rupture carrying a mortality risk as high as 81% 2
- The prevalence of AAA has declined over the past two decades in various European countries, but current U.S. prevalence is unclear due to low screening uptake 2