At what age are men typically screened for Abdominal Aortic Aneurysm (AAA)?

AAA Screening Age for Men

Men should receive one-time ultrasound screening for abdominal aortic aneurysm (AAA) between ages 65-75, with the strongest recommendation for those who have ever smoked. 1, 2, 3

Primary Screening Recommendations

Men Ages 65-75 Who Have Ever Smoked

• This is a Grade B recommendation from the U.S. Preventive Services Task Force, meaning routine screening is strongly recommended for all men in this category. 1, 3
• One-time ultrasound screening reduces AAA-specific mortality by approximately 50% in this highest-risk population. 1, 2
• "Ever smoked" is defined as having smoked at least 100 cigarettes in their lifetime. 4
• The screening should occur at age 65, as this single scan effectively identifies the majority of clinically significant AAAs and provides protection for up to 10 years. 5, 6

Men Ages 65-75 Who Have Never Smoked

• Selective screening may be offered rather than routine screening for all men in this group (Grade C recommendation). 1, 3
• Consider screening if additional risk factors are present, including: 7
  • Family history of AAA
  • Coronary artery disease
  • Peripheral artery disease
  • Previous myocardial infarction
  • Hypertension
• The prevalence of large AAAs is substantially lower in never-smokers, resulting in smaller potential benefit from universal screening. 3

Screening Method

• Ultrasonography is the screening modality of choice, with sensitivity approaching 95-100% and specificity near 100%. 1, 2
• The ultrasound should be performed in an accredited facility with credentialed technologists to ensure quality. 1, 3
• AAA is defined as aortic diameter ≥3.0 cm. 2, 4
• Only 1-2% of cases fail to visualize the aorta adequately due to bowel gas or anatomical challenges. 1

Important Clinical Considerations

Why Age 65 is Optimal

• Age >60 years is a major risk factor for AAA development. 4
• Screening at age 65 captures the population at highest risk while minimizing unnecessary surveillance. 5
• Evidence demonstrates that men with normal aortic diameter (<3.0 cm) at age 65 have extremely low risk of developing clinically significant AAA over the next 10 years (only 1 rupture per 1000 scans). 5
• Among men with initially normal aortas at age 65, only 0.7% developed AAA by age 70. 6

Special Populations Requiring Earlier Consideration

• First-degree relatives of patients with AAA should be screened starting at age 50 years, per European Society of Cardiology recommendations. 1
• Family history is a significant independent risk factor that warrants screening outside standard age guidelines. 1, 4

Common Pitfalls to Avoid

• Underutilization is a major problem—only 13-26% of eligible men receive screening despite clear mortality benefit. 1
• Do not repeat screening if initial aortic diameter is normal; there is negligible benefit to repeat screening. 2
• Do not dismiss screening in never-smokers who have strong family history or multiple cardiovascular risk factors. 7
• Male gender itself is an independent risk factor, so age and smoking history should not be the only considerations in borderline cases. 4