AAA Screening Guidelines

Men aged 65-75 who have ever smoked should receive one-time screening for abdominal aortic aneurysm with ultrasonography. 1, 2, 3

Screening Recommendations by Population

One-time ultrasound screening is strongly recommended for men ages 65-75 with any smoking history (Grade B recommendation), as this reduces AAA-specific mortality by approximately 50%. 1, 3
This represents the highest-yield screening population with the clearest mortality benefit. 1

Selective screening may be offered rather than routine screening for men ages 65-75 who have never smoked (Grade C recommendation). 1, 4, 3
Consider screening in this group if additional risk factors are present, including family history of AAA, coronary artery disease, hypertension, or peripheral artery disease. 5
The prevalence of large AAAs is substantially lower in never-smokers, resulting in smaller absolute benefit. 4

Women who have never smoked should NOT receive routine AAA screening (Grade D recommendation), as harms outweigh benefits. 1, 3
For women ages 65-75 who have ever smoked or have a family history of AAA, evidence is insufficient to recommend for or against screening (I statement). 1, 3
Opportunistic screening during transthoracic echocardiography may be considered for women aged ≥75 years who are current smokers or hypertensive. 2

First-degree relatives of AAA patients aged ≥50 years should be screened, as lifetime prevalence reaches 32% in brothers of affected patients. 1, 2

Ultrasonography is the screening modality of choice, with sensitivity and specificity approaching 100%. 6, 4
Screening must be performed in an accredited facility with credentialed technologists to ensure quality assurance. 1, 4
Color Doppler is not required for screening but may be used as an adjunct. 6
Ultrasound fails to visualize the aorta adequately in only 1-2% of cases due to bowel gas or anatomical challenges. 6

One-time screening is sufficient when initial aortic diameter is <3.0 cm, as there is negligible benefit to rescreening. 2

The surveillance strategy is size-dependent and differs from initial screening:

AAA 3.0-3.9 cm: Ultrasound every 3 years (Class I, Level B-NR). 2
AAA 4.0-4.9 cm in men or 4.0-4.4 cm in women: Annual ultrasound (Class I, Level B-NR). 2
AAA ≥5.0 cm in men or ≥4.5 cm in women: Ultrasound every 6 months given potential for rapid growth (Class I, Level B-NR). 2

Surgical repair (open or endovascular) is generally recommended for aneurysms ≥5.5 cm in diameter or those growing rapidly. 1, 4, 5

Confusing screening with surveillance: Screening refers to one-time detection in asymptomatic at-risk populations, while surveillance refers to ongoing monitoring of a known aneurysm. 2
Overlooking family history: This is a critical risk factor that may warrant screening outside standard age/smoking criteria. 1
Underutilization in eligible populations: Screening rates in the target population range only 13-26% despite clear mortality benefit. 6
Not considering family history as an important risk factor that may warrant screening outside standard guidelines. 1