Lederle FA: Ultrasonographic screening for abdominal aortic aneurysms. Ann Intern Med 2003;139(6):516-522.

The U.S. Preventive Services Task Force is currently reconsidering its recommendation against abdominal aortic aneurysm (AAA) screening. Recent randomized trials have shown a reduced mortality with ultrasonographic screening and elective repairs. The prevalence of AAAs 3 cm or larger is the lowest in women who never smoked (0.4%) and is the greatest by a factor of 12-15 in men who currently or previously smoked.

For screening to have benefit, it is important that patients with small AAAs detected at screening are not put at risk from unnecessary procedures. Currently, about 1 in 6 of AAA-related deaths result from elective repair. Two randomized trials have shown that survival is not improved by elective repair of AAAs smaller than 5.5 cm diameter, however the tendency remains in the United States to repair smaller AAAs. One-time ultrasonographic screening should be offered to men 65 to 79 years of age who have ever smoked, especially if screening is accompanied by prudent use of elective surgical repair.