Screening for Abdominal Aortic Aneurysms in Older Men

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A one-time screening for abdominal aortic aneurysm in men 65 years or older is associated with decreased AAA rupture and AAA-related mortality rates, according to a new review published in Annals of Internal Medicine.

A release from the American College of Physicians explains that AAA is a weakening in the wall of the infrarenal aorta that results in localized dilation, or ballooning, of the abdominal aorta. A large proportion of AAAs are asymptomatic until a rupture develops, which is generally acute and often fatal. Up to 83 percent of patients die before making it to a hospital. Risk factors for AAA include advanced age, being male, smoking, and a family history. Smoking being the most important modifiable risk factor.

The United States Preventive Services Task Force (USPSTF) reviewed published evidence to update its previous recommendation on screening for AAA. The reviewers found convincing evidence that screening men aged 65 and older decreased AAA-related mortality rates by approximately 50 percent over 13 to 15 years. Determining the most effective and efficient approaches to population-based AAA screening was an important goal of the review. Critics of the 2005 recommendation for selectively screening men aged 65 to 75 who had ever smoked argued that the guidelines missed opportunities to prevent AAA rupture in women, younger nonsmoking males, and those with a family history. The reviewers maintain that targeting older male smokers is warranted because no single risk factor other than age, sex, or smoking history is as strong a predictor of AAA.