Abdominal Aortic Aneurysm: Screen Older Male Smokers, Says USPSTF

May 21, 2014

The United States Preventive Services Task Force narrows recommendations for populations that warrant screening. Guideline revisions are based on a new evidence review.

The overall incidence of abdominal aortic aneurysms (AAA) is low; however, the rate of associated morbidity and mortality after rupture is very high, thus close screening remains an important lifesaving intervention. When determining optimal candidates for screening, however, important issues that must be considered are the cost of screening, cost of surgery, the potentially associated morbidity, and the cost of surveillance.

The newest guidelines on screening1 (still awaiting finalization), which were recently released by the United States Preventive Services Task Force (USPSTF), include some noteworthy changes to previous versions. These revisiosn are based on results of an evidence review published in January 2014 in The Annals of Internal Medicine that suggested a reduction in AAA-related mortality (without a significant reduction in all-cause mortality) with one-time screening of asymptomatic men aged 65 years and older, at up to 15-year follow-up. The clinical risk factors for AAA that emerged from this analysis were male sex, older age, smoking, and family history. Of interest, black or Hispanic race and diabetes were associated with a relatively lower risk of having an AAA.

These recommendations, along with others from contemporary societies,1-3 are summarized in the Table. 

Comparison of the recommendations show significant variability among expert societies on AAA screening, especially in women. Therefore, the decision to screen each patient should be individualized based on a careful consideration of risk factors, such as family history, age, sex, and smoking history. However, the information in the Table serves as an outline that can be used to identify those groups that may and may not benefit from screening.

Table. Reccomendations for Screening for Abdominal Aortic Aneurysm

 USPSTF (2014)ACC/AHA (2010)Society for Vascular Surgery (2004)
Men• All smokers aged 65-75 y • Non-smokers aged 65-75 y,  elective screening on a case-by-case basis• Aged >60 y with relative with AAA, one-time screening •Smokers aged 65-75 y,  one-time screening • Nonsmokers without family history: not recommended• All aged 60-85 y • Aged ≥50 y with family history of AAA
Women• Smokers 65-75 y, insufficient evidence • Non-smokers aged 65-75 y, routine screening not recommended• Not recommended• Smokers aged 65-75 y • Non-smokers with family history of AAA • Age ≥50 y with family history of AAA

 

References:

  • Guirguis-Blake JM, Beil TL, Senger CA, Whitlock EP. Ultrasonography screening for abdominal aortic aneurysms: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2014 Jan 28. doi: 10.7326/M13-1844.
  • 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. Circulation. 2010;121:e266-e369.
  • Kent KC, Zwolak RM, Jaff MR, et al. Screening for abdominal aortic aneurysm: a consensus statementJ Vasc Surg. 2004;39:267-269.