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Screening for Abdominal Aortic Aneurysms

March 6, 2014

Screening for Abdominal Aortic Aneurysms

  1. Jamaluddin Moloo, MD, MPH

The latest evidence supports current recommendations to screen for AAAs in older men who have ever smoked.

  1. Jamaluddin Moloo, MD, MPH

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.

Comment

The USPSTF is expected to update its abdominal aortic aneurysm screening guidelines within the next few months. But, given the findings of this systematic review, substantial changes are unlikely.

  • Disclosures for Jamaluddin Moloo, MD, MPH at time of publication Grant / research support NIH

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Reader Comments (1)

Marati s Gopalakrishnan M .D F A CP Physician, Internal Medicine, retired

I liked and all the articles are good for practicing physcians

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