Review Question - QID 105666

The USPSTF recommends one-time ultrasound screening for AAA in men ages 65-75 years who have ever smoked.

AAA is a dilatation of the abdominal aorta, most commonly secondary to atherosclerosis. AAA may be asymptomatic or may present with a pulsatile sensation or back pain. Ruptured AAA is immediately life-threatening and may present with hypotension and severe tearing abdominal pain radiating to the back. Ultrasound is the gold standard for diagnosis. Surgery is indicated for large lesions (>5.5 cm diameter), rapidly enlarging lesions (>0.6 to 0.8 cm per year), or rupture.

Guirguis-Blake et al. note that the major risk factors for AAA include: an age of 65 years or older, male sex, and a history of smoking. Less important risk factors include: family history, coronary heart disease, claudication, hypercholesterolemia, hypertension, cerebrovascular disease, and increased height. Among men aged 65-75 who have ever smoked, the number needed to screen to prevent one AAA-related death in 5 years is approximately 500.

USPSTF, in the Annals of Internal Medicine in 2005, stated that screening for AAA and surgical repair of AAAs >5.5 cm in men age 65-75 years who have ever smoked (current and former smokers) leads to decreased AAA-specific mortality. Abdominal ultrasound has been shown to be an accurate screening test.

Illustration A shows the appearance of AAA on ultrasound. Note the focal dilation of the aorta. Normal abdominal aorta width is approximately 2 cm.

Incorrect Answers:
Answers 1,2,4: These patients are not indicated for AAA screening.
Answer 5: AAA is, in fact, recommended in some asymptomatic patients as discussed above.