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Abdominal Aortic Aneurysm: Should I Get a Screening Test?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Abdominal Aortic Aneurysm: Should I Get a Screening Test?
Get the facts
- Get a screening test for abdominal aortic aneurysm.
- Don't get a screening test.
If you already have symptoms of an abdominal aortic aneurysm and your doctor suspects that you have one, this topic is not for you. Your doctor will want you to have the test.
Key points to remember
- Most abdominal aortic aneurysms, or AAAs, never cause problems. But sometimes they burst, which is often deadly.
- Screening can find these aneurysms before they burst.
- Screening can be harmful for some people, because it can also find aneurysms that will never cause problems. This may lead to dangerous surgery that isn't really needed.
- People who are at higher risk for AAAs will get the most benefit from this test. You are at higher risk if you are a man who is:
- Age 65 to 75 and you have ever smoked.
- At least 60 years old and you have a first-degree relative (parent, brother, or sister) who has had an aortic aneurysm.
An aortic aneurysm (say "a-OR-tik AN-yuh-rih-zum") is a bulge in part of the aorta, the body's main artery. When this bulge is in the belly (abdomen), it's called an abdominal aortic aneurysm. It's often called "triple A" or "AAA" for short.
Abdominal aortic aneurysms are about 5 times more common in men than in women. An aneurysm happens in about 3 to 9 men out of 100 who are older than 50.1
These bulges are most common in men older than age 65, people with high blood pressure, and people who smoke. AAAs sometimes run in families.
Most aortic aneurysms never cause problems, especially if they're small and don't grow fast.
But if the bulge gets too big, it can burst, or rupture, which is often deadly.
When the bulge is small and not growing, it is safe to watch it carefully and wait to have treatment. Some of these aneurysms can be treated with medicine that lowers blood pressure.
Repair of the aneurysm is usually recommended for large AAAs or when the aneurysm is growing fast. It is also usually recommended when a blood clot from inside the aneurysm has caused problems with the circulation to the legs or feet.
There are two ways to repair an aneurysm.. One is traditional open surgery. The other is a less invasive procedure called endovascular repair, during which a tube called a stent graft is inserted through an artery in the groin.
Screening tests help your doctor look for a certain disease or condition before any symptoms appear. The AAA screening test is an ultrasound test. You lie on a table while a technician does the test. After the test, a radiologist looks at the pictures to see if you have an aneurysm.
AAA screening is fast and painless. It is usually done in the doctor's office or at a hospital. But it may also be offered at certain retail stores, where it may be inexpensive or even free. If there is a cost, your insurance may cover it if you are at risk for AAA and your doctor recommends screening.
- AAA screening can find large bulges that might rupture if they are not repaired.
- Screening can also find smaller bulges that can be treated with medicine or simply watched carefully over the years.
- A study of men ages 65 to 75 showed that those who have the screening are less likely to die of AAA rupture.2
It may seem obvious that AAA screening is good, because it might save your life by finding a bulge before it bursts. The test itself doesn't have risks. But what if you learn during the test that you have a bulge in your aorta? There's no way to know for sure if the bulge will rupture in the future. So you might decide to have surgery or a procedure to fix it. That's where the risks are.
Repairing an AAA can be very risky. The benefits outweigh the risks when the aneurysm is at risk of bursting. Repair of an AAA can cause problems later, like blood clots or problems with the stent graft in the aorta. And some people die during the operation or soon after.
- With open surgery (the surgeon makes a large cut in the belly and repairs the aorta), 4 to 8 out of 100 people die during surgery or within 30 days.1 That means 92 to 96 out of 100 people don't die during surgery or within 30 days.
- With an endovascular procedure, in which the surgeon inserts a tube called a stent graft through an artery in the groin, 1 out of 100 dies within 30 days.3 That means 99 out of 100 don't die within 30 days. But after this procedure, about 15 out of 100 people might need a second procedure or surgery to fix a problem with the stent, such as leaking or movement.4
You can see why it's so important to talk to your doctor about whether the benefits of AAA screening outweigh the risks in your case.
Your doctor is likely to recommend screening if you are a man who is:
- Age 65 to 75 and has ever smoked.5
- At least 60 years old, and you have a first-degree relative (for example, father or brother) who has had an aortic aneurysm.6
Some doctors think that other groups should be screened too. Some say all men 65 years and older should be screened, regardless of their risk. Some say men as young as 50 should be screened if they have a family history. Some say women age 65 and older should be screened if they have ever smoked or have a family history of AAA. Some say women should not be screened at all.
Talk to your doctor about whether the benefits of screening would outweigh the risks in your case.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You lie on your back on a table for the ultrasound. Warmed gel is spread on your belly. Then a small handheld device is pressed against your belly and moved back and forth over it.
- When the ultrasound is done, you may be asked to wait while a doctor looks at the pictures to see if you have an aneurysm.
- The screening usually takes 30 to 60 minutes.
- AAA screening can find a dangerously large aneurysm before it bursts.
- It can also find smaller AAAs that can be watched in the future.
- The test results may motivate you to stop smoking and to work on lowering your blood pressure.
- The test could lead you to have a risky surgery or procedure to fix an aneurysm that may never have caused trouble.
- You may have a lot of worry if the test finds a large AAA but you can't have it repaired because you have other health problems.
- If you have an AAA, it might be found during a routine physical exam or during an X-ray, ultrasound, or echocardiogram that's being done for other reasons.
- If you smoke, you could quit smoking to lower your risk of getting an abdominal aortic aneurysm.
- You avoid having to make a decision about whether to have an aneurysm repaired.
- You avoid the worry that might come from learning that you have an aneurysm, even though it may never cause you problems.
- You could have an aneurysm that remains undetected until it ruptures. A rupture is very dangerous.
Personal stories about considering AAA screening
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I have high blood pressure, and I'm a smoker. I've heard about AAAs and how people usually die when they burst. It's pretty scary. I figure it can't hurt to have the test. And I'll just feel better, because either I'll know I don't have an aneurysm or I'll find out I do have one and I can get treatment.
Hayden, age 59
My father died when his aneurysm ruptured. So I've been worried about my risk and decided to ask my doctor about it. She explained why this screening probably isn't for me, because even though I have a family history, I'm a woman, and my risk just isn't that high. I'm going to skip this test.
Sharon, age 69
I've never been a smoker, but I do have high blood pressure and high cholesterol. So I'm nervous about having an aneurysm that could rupture and maybe kill me. I heard about free screening I can get at a store in my neighborhood. I figure, why not? I'll have the peace of mind of knowing I have one less thing to worry about.
I smoked in college, but that was decades ago. My doctor says my heart is healthy. If I had the test and they found a small aneurysm, I'd worry about it all the time, probably for no reason. No, thanks! I'm not going to have the test now. Maybe in a few years, when my risk is higher.
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have AAA screening
Reasons not to have AAA screening
I'm very worried that I may have an aneurysm that could burst some day.
I'm not at all worried that I may have an aneurysm that could rupture.
I'm willing to have surgery that is very risky if screening shows I may need it.
I'm not willing to have surgery for an aneurysm.
I want the peace of mind of knowing that I don't have an aneurysm.
I don't need a test to give me peace of mind.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having AAA screening
NOT having AAA screening
What else do you need to make your decision?
Check the facts
Does AAA screening help prevent death from ruptured aneurysms?
- YesThat's right. Screening can find AAAs before they rupture, and a ruptured aneurysm is often deadly.
- NoSorry, that's not right. Screening can find AAAs before they rupture, and a ruptured aneurysm is often deadly.
- I'm not sureIt may help to go back and read "Get the Facts." Screening can find AAAs before they rupture, and a ruptured aneurysm is often deadly.
Can AAA screening be harmful?
- YesThat's right. Although the test itself is harmless, it could lead you to have risky surgery on an aneurysm that may never have caused a problem.
- NoSorry, that's not right. Although the test itself is harmless, it could lead you to have risky surgery on an aneurysm that may never have caused a problem.
- I'm not sureIt may help to go back and read "Get the Facts." Although the test itself is harmless, it could lead you to have risky surgery on an aneurysm that may never have caused a problem.
Which group is most likely to get AAAs?
- WomenSorry, but that's wrong. These aneurysms are most common in men older than age 65, people with high blood pressure, and people who smoke.
- Men age 45 to 60Sorry, but that's wrong. These aneurysms are most common in men older than age 65, people with high blood pressure, and people who smoke.
- Men older than age 65.You're right. These aneurysms are most common in men older than age 65, people with high blood pressure, and people who smoke.
- I'm not sureIt may help to go back and read "Get the Facts." These aneurysms are most common in men older than age 65, people with high blood pressure, and people who smoke.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||David A. Szalay, MD - Vascular Surgery|
- Braverman AC, et al. (2012). Diseases of the aorta. In RO Bonow et al., eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1309–1337. Philadelphia: Saunders.
- Fleming C, et al. (2005). Screening for abdominal aortic aneurysm: A best-evidence systematic review for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 142(3): 203–211.
- Lederle FA, et al. (2009). Outcomes following endovascular vs open repair of abdominal aortic aneurysm: A randomized trial. JAMA, 302(14): 1535–1542.
- Chaikof EL, et al. (2009). Care of patients with an abdominal aortic aneurysm: Society for Vascular Surgery practice guidelines. Journal of Vascular Surgery, 50(4, Suppl): S2–S49.
- U.S. Preventive Services Task Force (2005). Screening for Abdominal Aortic Aneurysm. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsaneu.htm.
- Hirsch AT, et al. (2006). ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): A collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation, 113(11): e463–e654.