Screening for Abdominal Aortic Aneurysms

Abdominal aortic aneurysms (AAAs) often go undiagnosed, because many remain asymptomatic until they rupture, so screening for AAAs is of substantial interest. In 2005, the U.S. Preventive Services Task Force (USPSTF) recommended one-time screening for AAA by ultrasonography in older men (age range, 65–75) who have ever smoked and recommended against routine AAA screening in women (NEJM JW Gen Med Feb 18 2005). In this systematic review, researchers examined more recent evidence to reevaluate AAA screening.

The effectiveness of one-time invitation for AAA screening with ultrasonography in older men (age, ≥65) was evaluated in four trials that involved ≈137,000 participants (mostly white; all outside the U.S.); AAA prevalence was 4% to 8%, and screening was associated (significantly, in 2 trials) with lower rates of AAA ruptures and AAA-related mortality (the latter, by as much as 50% for as long as 13–15 years) but had no significant effect on all-cause mortality. In the only trial that included women (≈9000 women; age range, 65–80), AAA prevalence was six times lower than in men, and screening yielded no benefit. Data were insufficient to evaluate screening efficacy in other subgroups, such as those characterized by race or ethnicity, family history of AAA, or smoking history.