Abdominal aortic aneurysm screenings should be routinely recommended only when a positive net benefit (benefits outweigh harms) exists. There is good evidence that screening and surgical repair of large aneurysms (5.5 cm or greater) in men 65-75 years of age.
Consequently a screening should be routinely recommended only when a positive net benefit (benefits outweigh harms) exists. There is good evidence that screening and surgical repair of large aneurysms (5.5 cm or greater) in men 65-75 years of age who have ever smoked leads to decreased deaths.
As a result only this group stands to benefit the most from early detection and reparative surgical treatment.
Women are at lower risk for AAAs. Thus, the net benefit from screening is small and routine screening is not recommended.
|AAA Size (cm)||Prevalence|
Source: Lederle et al. The Aneurysm Detection and Management Study Screening Program. Validation Cohort and Final Results. Arch Intern Med 2000; 160:1425-1430.
Consequently the main risk of an aneurysm is rupture. Most (75-90%) individuals with ruptured AAAs do not survive to hospital discharge. The risk of rupture is proportional to aneurysm size. Larger aneurysms are more likely to rupture than smaller aneurysms. Studies have documented benefit from surgical repair of aneurysms 5.5 cm and larger.
Because randomized controlled trials evaluated the benefit of screening found a AAA-related mortality rate of 0.33% in an unscreened population versus 0.19% in a screened population. Screening for AAA does not reduce all-cause mortality. Harms from screening include the morbidity and mortality from surgical repair for those with aneurysms needing treatment. Among men aged 65-75 who have ever smoked, the number needed to screen to prevent one AAA-related death within the next 5 years is 500.
Especially Relevant is the following Web site for tools and resources to help you assist your patients with quitting: http://www.publichealth.va.gov/smoking/publications.asp. You can also refer patients to the national quitline at 1-800-QUIT-NOW (1-800-784-8669).