Men between the ages of 65 and 75 who are or have been smokers should have a one-time ultrasound to screen for abdominal aortic aneurysm, according to a new recommendation from the U.S. Preventive Services Task Force. Nearly 70 percent of men in this age group have smoked and would benefit from routine screening to check for aneurysms. The recommendation is published in the February 1 issue of the Annals of Internal Medicine.
This is the first time the Task Force has recommended screening for abdominal aortic aneurysms. When the Task Force last reviewed the topic in 1996, the group found insufficient evidence to recommend screening for such aneurysms. New evidence shows that screening and surgery to repair large abdominal aortic aneurysms are effective at reducing the number of aneurysm-related deaths in men. Estimates indicate that between 59 percent and 83 percent of patients with ruptured abdominal aortic aneurysms die before they reach the hospital and have surgery.
Men ages 65 and older who currently are or have been regular smokers are at the highest risk for abdominal aortic aneurysm. Although few studies have been conducted in women, the published research indicates that women are at low risk for aneurysms. Death from an aneurysm is a rare event in women, and most of these deaths occur in women older than 80. The Task Force found no evidence of benefit from routine screening for abdominal aortic aneurysm in all women and concluded that potential harms of screening, from mortality and complications of surgery for aneurysms, outweighed potential benefits.
Because abdominal aortic aneurysm is significantly less likely to occur in people who have never smoked, the Task Force also found that screening those who have never smoked for abdominal aortic aneurysm would have little net benefit. Therefore, the Task Force made no recommendation either for or against routine screening for abdominal aortic aneurysm in men between the ages of 65 and 75 who have never smoked.
Abdominal aortic aneurysm is an abnormal ballooning of the aorta—the major artery from the heart—that occurs in the abdomen. Each year, such aneurysms cause approximately 9,000 deaths in the United States. This number may be an underestimate since the majority of people with ruptured aneurysms die before they reach a hospital, and their deaths may be attributed to other causes.
The Task Force found evidence that surgery to repair the aorta in people with an aortic diameter of at least 5.5 centimeters is effective to reduce the number of deaths caused by abdominal aortic aneurysm. Elective open surgery has an in-hospital mortality rate of 4.2 percent. Endovascular repair (EVAR) of abdominal aortic aneurysms has been shown to have short-term benefits comparable with open surgical repair, but the long-term effectiveness and harms of EVAR are not known. EVAR is a less-invasive procedure in which the surgeon repairs the aneurysm though a small incision in the patient's groin. The Agency for Healthcare Research and Quality (AHRQ) is sponsoring an evidence review to compare EVAR with open surgical repair of abdominal aortic aneurysms. The review should be completed and published in 2006.
The Task Force, which is supported by AHRQ, is the leading independent panel of private-sector experts in prevention and primary care. Task Force members conduct rigorous, impartial assessments of the scientific evidence for a broad range of preventive services. For this recommendation, the Task Force based its conclusions on a report from a research team led by Craig Fleming, M.D., at AHRQ's Oregon Evidence-based Practice Center in Portland, OR.
Details are in "Screening for abdominal aortic aneurysm: Recommendation statement," by the U.S. Preventive Services Task Force, in the February 1, 2005, Annals of Internal Medicine, 142(3), pp. 198-202. See also "Screening for abdominal aortic aneurysm: A best-evidence systematic review for the U.S. Preventive Services Task Force," by Craig Fleming, M.D., Evelyn P. Whitlock, M.D., M.P.H., Tracy L. Bell, M.S., and Frank A. Lederle, M.D., in the same journal, pp. 203-211. Select to access the recommendations online.
Editor's Note: Task Force recommendations and materials for clinicians are available on the AHRQ Web site at www.preventiveservices.ahrq.gov. Previous Task Force recommendations, summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials are also available from the AHRQ Publications Clearinghouse. Clinical information is also available from AHRQ's National Guideline Clearinghouse™ at www.guideline.gov.
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