From the Guidelines
Ultrasound screening for abdominal aortic aneurysm (AAA) is recommended as a one-time screening for men aged 65-75 who have ever smoked, and can be considered for men aged 65-75 who have never smoked. The screening involves a simple, non-invasive ultrasound examination of the abdomen to measure the diameter of the aorta. No preparation is typically required, though some facilities may ask patients to fast for 8-12 hours before the test. The procedure takes about 15-30 minutes and is painless. If an AAA is detected, management depends on its size:
- aneurysms less than 3.0 cm generally require no follow-up
- those 3.0-3.9 cm need ultrasound surveillance every 2-3 years
- those 4.0-4.9 cm need surveillance every 6-12 months
- and those 5.0 cm or larger typically warrant referral to a vascular surgeon for consideration of repair, as stated in the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1. Screening is valuable because AAAs are often asymptomatic until rupture, which has a high mortality rate. Early detection through ultrasound allows for monitoring or intervention before complications occur, potentially saving lives through this simple preventive measure. The American College of Radiology Appropriateness Criteria also support the use of ultrasound for AAA follow-up, highlighting its accuracy and reproducibility in assessing aneurysm size 1.
From the Research
Ultra Sound AAA
- The use of ultrasound in monitoring abdominal aortic aneurysm (AAA) is a common practice, as it is a non-invasive and effective method for measuring the size of the aneurysm 2.
- According to the Society for Vascular Surgery practice guidelines, surveillance imaging at 12-month intervals is recommended for patients with an AAA of 4.0 to 4.9 cm in diameter 3.
- Ultra sound can be used to monitor the growth of the aneurysm and to detect any potential complications, such as rupture or dissection.
- The effectiveness of ultra sound in monitoring AAA has been supported by various studies, including a systematic review and meta-analysis that found that ultra sound can accurately measure the size of the aneurysm and detect any changes in its size over time 4.
Management of AAA
- The management of AAA typically involves a combination of medical therapy, surveillance, and surgical repair 2.
- Medical therapy may include the use of beta-blockers, which have been shown to have a non-significant effect on aortic aneurysm growth 4.
- Surgical repair is typically recommended for large or symptomatic aneurysms, and may involve open or endovascular repair 3.
- Smoking cessation is also an important aspect of AAA management, as smoking has been shown to increase the risk of rupture and mortality 5, 6.
Risk Factors for AAA
- Smoking is a significant risk factor for AAA, and has been shown to increase the risk of rupture and mortality 5, 6.
- Other risk factors for AAA include hypertension, high cholesterol, and family history 2.
- The use of ultra sound to monitor AAA can help to identify individuals who are at high risk of rupture or other complications, and can inform treatment decisions 3.