Guide to Clinical Preventive Services 2012 - Agency for Healthcare ...

SCREENING FOR ABDOMINAL AORTIC ANEURYSMCLINICAL SUMMARY OF U.S. PREVENTIVE SERVICES TASK FORCE RECOMMENDATIONPopulationMen ages 65 to 75 years who haveever smokedMen ages 65 to 75 years who havenever smokedWomen ages 65 to 75 yearsRecommendationScreen once for abdominal aorticaneurysm with ultrasonography.Grade: BNo recommendation for or againstscreening.Grade: CDo not screen for abdominal aorticaneurysm.Grade: DRisk AssessmentThe major risk factors for abdominal aortic aneurysm include male sex, a history of ever smoking (defined as 100 cigarettesin a person’s lifetime), and age of 65 years or older.Screening TestsScreening abdominal ultrasonography is an accurate test when performed in a setting with adequate quality assurance (i.e.,in an accredited facility with credentialed technologists). Abdominal palpation has poor accuracy and is not an adequatescreening test.Timing of ScreeningOne-time screening to detect an abdominal aortic aneurysm using ultrasonography is sufficient. There is negligible healthbenefit in re-screening those who have normal aortic diameter on initial screening.InterventionsOpen surgical repair of an aneurysm of at least 5.5 cm leads to decreased abdominal aortic aneurysm-related mortality in thelong term; however, there are major harms associated with this procedure.Balance of Benefits and HarmsIn men ages 65 to 75 years who haveever smoked, the benefits of screeningfor abdominal aortic aneurysm outweighthe harms.In men ages 65 to 75 years who havenever smoked, the balance betweenthe benefits and harms of screeningfor abdominal aortic aneurysmis too close to make a generalrecommendation for this population.The potential overall benefit of screeningfor abdominal aortic aneurysm amongwomen ages 65 to 75 years is lowbecause of the small number ofabdominal aortic aneurysm-relateddeaths in this population and the harmsassociated with surgical repair.Other Relevant USPSTFRecommendationsThe USPSTF has made recommendations on screening for carotid artery stenosis, coronary heart disease, high bloodpressure, lipid disorders, and peripheral arterial disease. These recommendations are available athttp://www.uspreventiveservicestaskforce.org/.For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents,please go to http://www.uspreventiveservicestaskforce.org/.7