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Overview of Updated Abdominal Aortic Aneurysm Screening Guidelines

May 15, 2020

Overview of Updated Abdominal Aortic Aneurysm Screening Guidelines

The United States Preventive Services Task Force (USPSTF) released updated guidelines on abdominal aortic aneurysm (AAA) screening in December 2019. The USPSTF has not altered its AAA recommendations, but it has added verification of the benefit of AAA screening.

There are no changes to the recommendation statements from the previous (2014) USPSTF AAA guidelines. The 2019 guidelines continue to recommend one-time ultrasound screening for AAA in men aged 65-75 years who have ever smoked. In addition, the guidelines recommend selective screening for men aged 65-75 years who have never smoked or who have a family history of AAA. Clinicians are advised to consider and discuss the potential benefits and harms for individual patients in this group.1

The new sections in the guidelines communicate new evidence in the form of analyses demonstrating that appropriate AAA screening gains approximately 131 life-years per 1,000 people screened. For comparison, appropriate breast cancer screening gains an estimated 128 life-years per 1,000 women screened.2

Although AAA screening for patients who meet the at-risk criteria has been a covered benefit under Medicare and Medicaid since 2007, such screening is underused.2 Current utilization is calculated to be 1% to 20%, based on Medicare data and healthcare practitioner surveys.3 The authors of one review of screening urge “a multifaceted effort [to increase screening] ranging from provider and patient education to electronic health record reminders and point-of-care tools.” Increased screening, they state, “could have a positive impact on population health.”3 

In the latest guidelines, the USPSTF has not added any recommendations for AAA screening for other groups of patients. The assessment of the task force is that medical studies provide1:

  • Validation that there are no net benefits of screening women who have never smoked.
  • Insufficient information to support screening of women aged 65 to 75 years who have ever smoked or who have a family history of AAA.

Some other groups promulgating guidelines for AAA screening disagree with USPSTF about the advantages of screening for groups besides elderly men who have smoked. Guidelines from the Society for Vascular Surgery, for example, now call for AAA screening for men and women aged 65-75 years who have ever smoked; for men 55 years or older with a family history of AAA; and for women 65 years or older with a family history of AAA.2

The goal of AAA screening is to identify asymptomatic AAAs before they rupture, because ruptured AAA has a mortality rate of about 80%, while elective repair before rupture has a mortality rate of about 4%.2 

The information about additional life-years saved by appropriate AAA screening supports the continuation of screening. The fact that AAA screening is underutilized emphasizes the need for increased screening in keeping with current guidelines. The USPSTF believes future research is needed to determine if screening should be expanded to patient cohorts other than men.

LAMMICO’s Medical Interactive Community website offers two one-hour CME courses related to aortic aneurysms:

  • Aortic Disease I: Diagnosing Aneurysm
  • Aortic Disease II: Diagnosing Dissection

The current USPSTF Guidelines for Abdominal Aortic Aneurysm Screening are available here.

References

1. Abdominal Aortic Aneurysm: Screening. U.S. Preventive Services Task Force website.  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/abdominal-aortic-aneurysm-screening. December 2019.

2. Mell M. Screening for abdominal aortic aneurysm—a call to arms? JAMA Network Open. 2019;2(12):e1917168. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2757207. December 10, 2019.

3. Zucker EJ, Prabhakar AM. Abdominal aortic aneurysm screening: concepts and controversies. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S108-S117. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949596/pdf/cdt-08-S1-S108.pdf. April 2018.

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