This measure has an additional advantage of increasing the number of patients screened for an abdominal aortic aneurysm. Screening (usually by US but can be by CT/MRI) is recommended by the United States Preventive Services Task Force (USPSTF) one time for men aged 65-75 who have ever smoked and should be considered in men aged 65-75 who never smoked, especially if there is a family history. The USPSTF is less clear on women, but screening can be considered in women aged 65-75 who have ever smoked.⁶ The Society for Vascular Surgery agrees with the one-time screening of men aged 65-75 who have ever smoked but also recommends screening men 55 and older (one time) who have a family history of AAA, and women 65 and older with a family history of AAA.⁷ They recommend consideration of screening women over 65 years with a significant smoking history.

rAAA is a rare entity, however screening identifies individuals at risk and allows for monitoring of smaller AAAs, and elective repair of larger AAAs to avoid rupture. Elective repair carries a much lower mortality/morbidity risk than emergency repair, even when the latter is performed using an endovascular technique. However, nationally just 40 percent of patients are screened. Patients in lower resourced and socioeconomic areas are less likely to be screened.⁸

Dr. Schneider currently is the Senior Vice President for Clinical Affairs at ACEP and adjunct professor of emergency medicine at the University of Pittsburgh.

References

1. Sweeting MJ, Thompson SG, Brown LC, et al. Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms. Br J Surg 2012;99:655-665.
2. Sayers R. Bailey & Love’s short practice of surgery, 26th ed. Boca Raton, FL:CRC Press; 2013.
3. Gunnarsson K, Wanhainen A, Björck M, et al. Nationwide study of ruptured abdominal aortic aneurysms during twenty years (1994–2013). Ann Surg 2021; 274: e160-e166.
4. Lloyd GM, Bown MJ, Norwood MG, et al. Feasibility of preoperative computer tomography in patients with ruptured abdominal aortic aneurysm: a time-to-death study in patients without operation. J Vasc Surg. 2004 Apr;39:788-91.
5. Metcalfe D, Sugand K, Thrumurthy SG, et al. Diagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort study. Eur J Emerg Med. 2016; 23:386-90.
6. US Preventive Services Task Force; Owens DK, Davidson KW, Krist AH, et al. Screening for Abdominal Aortic Aneurysm: US Preventive Services Task Force Recommendation Statement. JAMA. 2019;322:2211-2218.
7. Patients with abdominal aortic aneurysm. https://vascular.org/node/87. Accessed 2/3/24.
8. Ho VT, Tran K, George EL, et al. Most privately insured patients do not receive Federally recommended abdominal aortic aneurysm screening. J Vasc Surg 2023;77:1669-`673.