Who should be screened for an abdominal aortic aneurysm (AAA)?

Barry T. Katzen, MD
Diagnostic Radiology
Until recently, AAA screenings were reserved for men 65 to 75 years old who were current or former smokers. The U.S. Preventive Services Task Force has since updated its guidelines to allow wider use of screenings in older men who have never smoked. The new screening guidelines take into account family history, which is the strongest risk factor in developing this type of aneurysm and more significant than smoking history.
If family history of AAA is known, a doctor is likely to examine the person for an aneurysm through a physical exam of the abdomen. If an aneurysm is detected, the doctor will then use ultrasound to gauge its size and location.
Many aneurysms are found coincidently -- such as when someone has a CT scan for back pain or an ultrasound of the abdomen -- because they typically don’t cause symptoms until they rupture. With the updated guidelines, the hope is to find more aneurysms that are manageable, either through frequent monitoring or through procedures to repair them before they burst.
Abdominal aneurysms are very rare in women -- one case to every eight in men. The exact reason men are more inclined to have these aneurysms isn't known, but it's believed there may be a genetic link.
Once an aneurysm is discovered, the goal is to prevent a life-threatening rupture. 
Risk factors for abdominal aortic aneurysm include:

- a history of vascular disease, particularly atherosclerotic disease

- smoking

- high blood pressure

- diabetes

- advanced age

- male gender

- family history of aortic aneurysm


People who have risk factors for vascular disease, such as smoking, and are age 65 years or older should be screened for aortic aneurysm. The screening is a simple, painless, noninvasive test that typically involves an abdominal ultrasound that quickly determines whether or not you have an aneurysm. People with a family history of aneurysm are typically screened at a younger age, usually by age 55.

People at highest risk for developing an abdominal aortic aneurysm include older men who smoke, or have smoked in the past. Aneurysms are more common in white males, but occur in women and in people of other races. Most aneurysms do not cause any symptoms and cannot easily be found on physical exam.

People who should be screened include men and women who are current or past smokers and are 65 years of age or older. In addition, people with a family history of aneurysms over the age of 50 should be screened.

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