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Screening for Abdominal Aortic Aneurysms

Guideline Watch |
July 10, 2014

Screening for Abdominal Aortic Aneurysms

  1. Jamaluddin Moloo, MD, MPH

The USPSTF continues to recommend screening primarily in 65- to 75-year-old men who have ever smoked.

  1. Jamaluddin Moloo, MD, MPH

Sponsoring Organization: U.S. Preventive Services Task Force (USPSTF)

Target Audience: Primary care clinicians

Background

Prevalence of abdominal aortic aneurysms (AAAs; defined by an aortic diameter of ≥3.0 cm) in adults older than 50 is as high as 7% in men and 1% in women. In 2005, the USPSTF recommended one-time screening by ultrasonography in 65- to 75-year-old men who had ever smoked (defined as having ever smoked ≥100 cigarettes) and recommended against routine screening in women (NEJM JW Gen Med Feb 18 2005). The USPSTF now has updated its recommendations.

Key Points

—Risk factors: Older age; positive smoking history; having a first-degree relative with AAA; and having a history of vascular aneurysms, coronary artery disease, cerebrovascular disease, hypercholesterolemia, obesity, or hypertension.

—As in 2005, the Task Force continues to recommend:

  • One-time screening for AAAs with ultrasound in 65- to 75-year-old men who have ever smoked (Grade: B [recommend]).

  • Selective screening for AAAs in 65- to 75-year-old men who have never smoked, if additional risk factors are present (Grade: C [recommend for selected patients]).

  • No screening for women who have never smoked (Grade D: [recommend against]).

—The Task Force finds insufficient data to determine the balance of benefits and harms of screening for AAAs in 65- to 75-year-old women who have ever smoked (Grade: I [no recommendation]).

—Screening test: Abdominal duplex ultrasonography has sensitivity and specificity of 97% and 99%, respectively, and is the standard approach for AAA screening.

—Treatment:

  • Refer patients with large AAAs (≥5.5 cm) for open repair or endovascular intervention.

  • For smaller AAAs (3.0–5.4 cm), manage patients conservatively (e.g., with repeat ultrasonography every 3–12 months).

—Screening in men is associated with an absolute risk reduction in AAA-related death of 1.4 per 1000 men screened.

What's Changed

  • In 2005, the USPSTF recommended against routine AAA screening in all women.

Comment

In this update, the USPSTF recommends one-time screening for AAAs with ultrasonography in 65- to 75-year-old men with smoking histories. This recommendation generally mirrors that of other organizations.

  • Disclosures for Jamaluddin Moloo, MD, MPH at time of publication Grant / Research support Colorado Health Foundation

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