The case for expanding abdominal aortic aneurysm screening

Both the U.S. Preventive Services Task Force and the UK National Institute for Health and Care Excellence are re-evaluating their screening paradigms for abdominal aortic aneurysms (AAAs). Currently, most countries that screen for AAA do so only in male ever-smokers between the ages of 65 and 75 years and in patients with a family history of AAA. However, these recommendations are based primarily on screening trials predating the endovascular era. The wider applicability of endovascular aneurysm repair and its safety profile, especially in the elderly, have changed the risk-benefit of repair and, by extension, screening. This is despite the decreasing prevalence of AAA thanks to improved medical therapies and lower smoking rates. This evidence summary critically examines the evidence behind screening and the potential for expanded screening.