Screening

Ultrasonography is the most widely used screening and surveillance imaging method for the evaluation of AAA.[6]​ Ultrasonography is safe, portable, easy to operate, and proven beneficial for screening of AAA, with high sensitivity and specificity and a high accuracy comparable to computed tomography, magnetic resonance imaging, or magnetic resonance angiography.[6]​[94]​​

Screening 65-year-old men for AAA significantly reduces AAA-specific mortality.[95][96][97]​​​

US Preventive Services Task Force (USPSTF) recommendations include:[4][5]​ 

  • One-time screening for AAA with ultrasonography in men ages 65 to 75 years who have ever smoked

  • Selective screening (based on an assessment of risk factors, including older age and a first-degree relative with a AAA) for AAA in men ages 65 to 75 years who have never smoked.

There is insufficient evidence for benefit of one-time AAA population screening for women.[4]​​[98][99]​​ The USPSTF concludes with moderate certainty that the harms of screening for AAA in women ages 65 to 75 years who have never smoked and have no family history of AAA outweigh the benefits.[4] The USPSTF maintains that there is insufficient evidence to assess the balance of benefits and harms of screening for AAA in women ages 65 to 75 years with risk factors for AAA (ever smoked or with a family history of AAA).[4]​ However, this patient group is included in the screening guidelines from the Canadian Society for Vascular Surgery, and the American College of Cardiology/American Heart Association (ACC/AHA) recommend that screening of female smokers is cost effective.[5][100]​​

Some data suggest that the USPSTF screening criteria detect fewer than one third of patients who ultimately undergo surgical repair of AAA; two groups at particular risk of AAA requiring surgical intervention but who are currently excluded from the screening guidelines include people under the age of 65 who smoke and those over 70 who have never smoked.[101]​ It has been postulated, therefore, that expanding the screening criteria for AAA may be reasonable and justified.[102]

Use of this content is subject to our disclaimer