Abdominal Aortic Aneurysm Screening Recommendations

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

Screening by Population Group

One-time ultrasonography screening is strongly recommended (Grade B recommendation). 1, 2
This population has the highest prevalence of AAA and derives the greatest mortality benefit from screening, with approximately 50% reduction in AAA-specific mortality. 1
Screening rates remain disappointingly low at only 13-26% despite clear mortality benefit, representing a significant missed opportunity. 1

Selective screening may be offered rather than routine screening for all men in this group (Grade C recommendation). 1, 3, 2
The prevalence of large AAAs is substantially lower in never-smokers compared to ever-smokers, resulting in smaller potential benefit. 3
Consider screening if other risk factors are present, particularly family history of AAA. 1

Routine screening is not recommended (Grade D recommendation). 4, 1, 2
AAA is rare in women who have never smoked, and harms of screening outweigh benefits. 4, 3

Current evidence is insufficient to recommend for or against screening (I statement). 4, 1, 2
The USPSTF has not established clear benefit in this population, though some European guidelines suggest consideration in women ≥75 years who are current smokers or hypertensive. 4

Screening should be considered for first-degree relatives aged ≥50 years regardless of smoking status. 4, 1
Family history represents an important independent risk factor that warrants screening outside standard age-based guidelines. 1

Abdominal ultrasonography is the screening modality of choice, with sensitivity and specificity approaching 100%. 1, 3, 5
The test is safe, painless, non-invasive, and takes fewer than 10 minutes to perform. 3, 5
Ultrasound fails to adequately visualize the aorta in only 1-2% of cases due to bowel gas or anatomical challenges. 1
Color Doppler is not required for screening but may be used as an adjunct. 1

Screening must be performed in an accredited facility with credentialed technologists to ensure adequate quality assurance. 6, 1, 3
This quality standard is critical for maintaining the accuracy and reliability of screening results. 6

Periodic monitoring with ultrasound surveillance is recommended; early elective surgery does not save lives. 1, 3, 5
There is no difference in outcomes between early elective surgical repair and surveillance for aneurysms 4.0-5.4 cm. 5
Approximately 3% of small aneurysms may rupture during surveillance, a risk that should be communicated during informed consent. 5

Surgical intervention is generally recommended. 4, 1, 3
Elective surgical repair carries approximately 5-7% operative mortality risk, substantially lower than the 80-90% mortality associated with rupture. 5

A one-time screen is sufficient for population-based screening programs. 5
Repeated screening is not necessary for patients with initial negative scans, as the development of large AAAs after a negative screen is rare. 5

Underutilization remains the primary concern, with screening rates of only 13-26% in eligible populations despite Medicare coverage since 2007 and clear mortality benefit. 1, 7
Less than 1% of aneurysms will not be visualized on initial screen, and a re-screen may be necessary; this should be communicated to patients. 5
Not considering family history as an important risk factor that may warrant screening outside standard age and smoking-based guidelines. 1
Psychological harms from screening are minimal, with little evidence of severe psychological distress associated with AAA screening. 5
Electronic medical record best practice alerts can dramatically reduce unscreened patients from 51.74% to 20.26% in integrated health systems. 7