June is Men’s Health Month, and this is a good opportunity to raise a test that takes about fifteen minutes. Screening for an Abdominal Aortic Aneurysm involves no needles and no radiation, is usually done once in a lifetime, and is nonetheless skipped by most of the men who should have it.
What an Abdominal Aortic Aneurysm Is
The aorta is the main artery carrying blood from the heart down through the chest and abdomen. In some people the wall of the aorta weakens and the vessel gradually widens, which is what an aneurysm is. A widened aorta is not in itself an emergency, and it is quietly progressive.
The difficulty is that an abdominal aortic aneurysm almost never announces itself. It causes no pain and no symptoms while it is enlarging. If it ruptures, the situation becomes immediately life-threatening, and outcomes after a rupture are poor. If it is found beforehand, it can be watched, managed, and repaired on a planned basis, which is an entirely different proposition.
That gap between a silent condition and a catastrophic event is the entire argument for screening.
Screening for an Abdominal Aortic Aneurysm: Who is it For?
The U.S. Preventive Services Task Force recommends a one-time screening ultrasound for abdominal aortic aneurysm in men aged 65 to 75 who have ever smoked.
That is a grade B recommendation, and “ever smoked” is a low bar rather than a high one, covering former smokers as much as current ones.
For men aged 65 to 75 who have never smoked, the Task Force recommends that clinicians offer screening selectively rather than routinely, weighing family history, medical history, and other risk factors alongside the patient’s own preferences.
For women the guidance differs. The Task Force found insufficient evidence to assess the balance of benefits and harms in women aged 65 to 75 who have ever smoked or who have a family history, and it recommends against routine screening in women who have never smoked and have no family history.
Family history is worth raising with your physician in any case. An aneurysm in a parent or sibling is a meaningful risk factor and it changes the conversation regardless of which category you otherwise fall into.
What Screening for an Abdominal Aortic Aneurysm Involves
It is a standard abdominal ultrasound. You lie on your back, a sonographer applies gel and moves a probe across your abdomen, and the aorta is located and measured. There is no radiation, no contrast, no IV, and no recovery. You will usually be asked to fast beforehand, because bowel gas interferes with the images.
A radiologist reviews the images and reports the measurement to your physician. Most results are normal, and a normal result in this age group generally means no further screening is needed.
What If Something Is Found While Screening for an Abdominal Aortic Aneurysm
A measurement above the normal range does not mean surgery. Most screen-detected aneurysms are small, and small aneurysms are managed with periodic ultrasound surveillance at intervals determined by their size, along with blood pressure control and smoking cessation, which does more to slow progression than anything else available.
Repair is considered when an aneurysm reaches a size where the risk of rupture outweighs the risk of treating it, or when it is enlarging quickly. That decision belongs to a vascular specialist, and it rests on measurements that come from imaging.
The practical point is that a planned repair and an emergency after a rupture are not the same event, and screening is what puts a patient in the first category rather than the second.
Why Uptake Stays Low
Screening rates for this test have been persistently low, and the reasons are not mysterious. There are no symptoms to prompt a visit, the test is not part of a familiar annual routine the way a mammogram or a colonoscopy is, and it is easy for a single one-time recommendation to fall off the list during a busy appointment.
Which means the burden often falls on the patient to raise it.
What to Ask When Screening for an Abdominal Aortic Aneurysm
If you are a man between 65 and 75 and you have ever smoked, even if you quit decades ago, ask your primary care physician whether screening for an abdominal aortic aneurysm is right for you. If you have a parent or sibling who had an aneurysm, say so, whatever your age or sex.
It is one ultrasound. For most men who have it, the answer is reassuring and they never think about it again.
References
U.S. Preventive Services Task Force. Abdominal Aortic Aneurysm: Screening. Final Recommendation Statement, December 10, 2019. uspreventiveservicestaskforce.org
Society for Vascular Surgery. Practice Guidelines on the Care of Patients with an Abdominal Aortic Aneurysm. vascular.org
RadiologyInfo.org. Abdominal Aortic Aneurysm (AAA). radiologyinfo.org
