Should You Be Screened for Abdominal Aortic Aneurysm (AAA)?

Alan Gesek/Stocktrek Images/Getty Images

An abdominal aortic aneurysm (AAA) is a balloon-like dilation of a section of the aorta within the abdomen. (The aorta is the major artery in the body, that carries all the blood pumped by the heart.) An AAA can suddenly rupture, leading to catastrophic internal bleeding, and most often to death. Death from a ruptured AAA is usually quite sudden.

Ruptured AAA is thought to be responsible for 15,000 deaths each year in the U.S. For this reason, people who have an AAA should be considered for elective surgery to repair the aneurysm, in order to prevent rupture.

- Read about the treatment of AAA.

Since most abdominal aortic aneurysms (AAA) cause no symptoms whatsoever before they rupture, screening for abdominal aortic aneurysms is recommended for certain individuals who are at increased risk.

How Is Screening Done?

Screening for AAA is pretty simple. The screening test that is most commonly used is the ultrasound (echo) test, a virtually risk-free test that uses sound waves to measure the size of the aorta in the abdomen. The ultrasound test can detect whether an AAA is present, and also whether it is large enough to warrant the consideration of surgical repair.

Who Should Be Screened?

As is the case with many screening tests in medicine, the question of who should and should not have screening for AAA is a bit controversial. 

While the rupture of an AAA is usually a catastrophic event, most AAAs never rupture. Widespread screening for AAA would be very expensive and could also result in many people being labeled as having a serious medical condition, even if they only have small AAAs which are very unlikely to ever rupture.

It could also lead to unnecessary surgery, if doctors choose to operate on AAA that are relatively unlikely to rupture.

These considerations have led the United States Preventive Services Task Force (USPSTF) to recommend AAA screening for only those who are at the highest risk.

What Are the Current Guidelines for AAA Screening?

Currently, the USPSTF recommends screening (specifically, a single ultrasound test) only for men between the ages of 65 and 75 who have ever been smokers.

No screening is recommended for women, or for younger or older men, or for men who have never smoked. If the single screening test shows no AAA, no further screening is recommended. Most international guidelines for AAA screening are similar to those of the USPSTF.

Are the Guidelines Sufficient?

Many have argued that the USPSTF guidelines for AAA screening are too restrictive. For instance, over 40% of the deaths from AAA rupture occur in women, and almost a quarter of the deaths occur in nonsmokers, and none of these individuals would have been screened under current guidelines. Read more about cardiovascular disease in women.

So some groups, such as the Society for Vascular Surgery (a group which, to be sure, stands to gain if more AAAs are diagnosed), have called for liberalized screening guidelines. The society has recently published a scientific paper justifying much broader guidelines for screening for AAA.

So, Should YOU Be Screened for AAA?

While the experts wrestle over the guidelines, here is how you might think about screening for AAA.

If you are a man between 65 and 75 years of age, and you have ever been a smoker, you should certainly be screened.

You might also consider being screened, and should discuss screening with your own doctor, if either of the following is true:

• You are a woman over 65 and have been a smoker.

• You are a man or woman with a strong family history of ruptured AAA.


Chaikof EL, Brewster DC, Dalman RL, et al. The Care of Patients With an Abdominal Aortic Aneurysm: the Society for Vascular Surgery Practice Guidelines. J Vasc Surg 2009; 50:S2.

Kent KC, Zwolak R, Egorova N, et al. Analysis of Risk Factors for Abdominal Aortic Aneurysm in a Cohort of More Than 3 Million Individuals. J Vasc Surg 2010; DOI: 10.1016/j.jvs.2010.05.090.

LeFevre ML, U.S. Preventive Services Task Force. Screening for Abdominal Aortic Aneurysm: U.S. Preventive Services Task Force Recommendation statement. Ann Intern Med 2014; 161:281.

Continue Reading