Abdominal aortic aneurysm screening recommended for some men

Journal of Family Practice, May, 2005 by C. Fleming, E.P. Whitlock, T.L. Beil, F.A. Lederle

Fleming C, Whitlock EP, Beil TL, Lederle FA. Screening for abdominal aortic aneurysm: a best-evidence systematic review for the US Preventive Services Task Force. Ann Intern Med 2005; 142:203-211.

US Preventive Services Task Force. Screening for abdominal aortic aneurysm: recommendation statement. Ann Intern Med 2005, 142:198-202.

* Clinical Question

Who, if anyone, should be screened for the presence of an abdominal aortic aneurysm?

* Bottom Line

The US Preventive Services Task Force recommends a one-time screening for abdominal aortic aneurysm (AAA) by ultrasound in men aged 65 to 75 years who have ever smoked. They make no recommendation for men who haven't smoked and recommend against screening women. (LOE=la)

Study Design Practice guideline

Setting Various (guideline)

Synopsis

In a turnabout based on new information from clinical trials, the US Preventive Services Task Force recommends a one-time screening for AAA, by ultrasound, of men aged 65 to 75 years who have ever smoked. This is a grade B recommendation (fair evidence of benefit) and is based on good evidence that screening for, and the repair of, AAAs at least 5.5 cm decreases AAA-related mortality. Prevalence of AAA in men who have not smoked is lower and the benefits may not outweigh the risks in this group; for these reasons the Task Force issued no recommendation for this group (grade C recommendation).

Women have an even lower prevalence, and the Task Force assembled good evidence that screening and early treatment can result in an increased number of surgeries leading to greater morbidity and mortality. For this reason they concluded that the harms of screening women for AAA outweigh the benefits, and screening should not be performed in this group (grade D recommendation).