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Abdominal Aortic Aneurysm: Should I Get a Screening Test

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Decision Point

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.

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Abdominal Aortic Aneurysm: Should I Get a Screening Test?

1

Get the
facts

2

Compare
Options

3

Your
Feelings

4

Your
Decision

5

Quiz
Yourself

6

Your Summary

Get the facts

Your options

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.

FAQs

What is an abdominal aortic aneurysm (AAA)?

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.

These aneurysms happen in about 1 out of 100 men ages 45 to 54. But they occur more often as people get older: up to 12 out of 100 men ages 75 to 84 get them.¹ Women are 2 to 5 times less likely than men to have an AAA.²

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.

What is the treatment for AAA?

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.

Surgery 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 types of surgery. One is traditional open surgery. In the other, newer type of surgery-called endovascular repair-a tube called a stent graft is inserted through an artery in the groin.

What is the screening test for AAA?

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 simply 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.

What are the benefits?

AAA screening can find large bulges that might rupture if 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.³

What are the risks?

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 to fix it. That's where the risks are.

AAA surgery is very risky. It 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 6 out of 100 people die during surgery or within 30 days.⁴ That means 94 to 96 out of 100 people don't die during surgery or within 30 days.
With stent graft surgery (the surgeon inserts a tube called a stent graft through an artery in the groin), 1 out of 100 die within 30 days.⁴ That means 99 out of 100 don't die within 30 days. Not everyone can have this surgery. And some doctors still have concerns about how well it works over the long term.

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.

Why might your doctor recommend screening?

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.¹

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

Compare


What is usually involved?
What are the benefits?
What are the risks and side effects?

Get screened for AAA Get screened for AAA

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 risky surgery to fix an aneurysm that may never cause trouble.
You may have a lot of worry if the test finds a large AAA but you can't have surgery because you have other health problems.

Don't get screened for AAA Don't get screened for AAA

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 surgery for an aneurysm found during the test.
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

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

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.

Jerry, 68

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.

Abed, 60

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.

More important

Equally important

More important

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.

More important

Equally important

More important

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.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

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

Leaning toward

Undecided

Leaning toward

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

What matters to you

Credits and References

Credits

Credits	Healthwise Staff
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	David A. Szalay, MD - Vascular Surgery

References

Citations

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.
Eagle KA, Armstrong WF (2007). Disease of the aorta. In DC Dale, DD Federman, eds., ACP Medicine, section 1, chap. 12. New York: WebMD.
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.
Isselbacher EM (2008). Abdominal aortic aneurysms section of Diseases of the aorta. In P Libby et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed., pp. 1458–1469. Philadelphia: Saunders Elsevier.
U.S. Preventive Services Task Force (2005). Screening for Abdominal Aortic Aneurysm: Recommendation Statement (AHRQ Publication No. 05–0569-A). Rockville, MD: Agency for Healthcare Research and Quality. Also available online: http://www.ahrq.gov/clinic/uspstf/uspsaneu.htm.

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?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the facts

Your options

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.

FAQs

What is an abdominal aortic aneurysm (AAA)?

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.

These aneurysms happen in about 1 out of 100 men ages 45 to 54. But they occur more often as people get older: up to 12 out of 100 men ages 75 to 84 get them.¹ Women are 2 to 5 times less likely than men to have an AAA.²

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.

What is the treatment for AAA?

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.

Surgery 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 types of surgery. One is traditional open surgery. In the other, newer type of surgery-called endovascular repair-a tube called a stent graft is inserted through an artery in the groin.

What is the screening test for AAA?

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 simply 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.

What are the benefits?

AAA screening can find large bulges that might rupture if 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.³

What are the risks?

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 to fix it. That's where the risks are.

AAA surgery is very risky. It 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 6 out of 100 people die during surgery or within 30 days.⁴ That means 94 to 96 out of 100 people don't die during surgery or within 30 days.
With stent graft surgery (the surgeon inserts a tube called a stent graft through an artery in the groin), 1 out of 100 die within 30 days.⁴ That means 99 out of 100 don't die within 30 days. Not everyone can have this surgery. And some doctors still have concerns about how well it works over the long term.

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.

Why might your doctor recommend screening?

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.¹

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.

2. Compare your options

	Get screened for AAA	Don't get screened for AAA
What is usually involved?	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.	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.
What are the benefits?	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.	You avoid having to make a decision about whether to have surgery for an aneurysm found during the test. You avoid the worry that might come from learning that you have an aneurysm, even though it may never cause you problems.
What are the risks and side effects?	The test could lead you to have risky surgery to fix an aneurysm that may never cause trouble. You may have a lot of worry if the test finds a large AAA but you can't have surgery because you have other health problems.	You could have an aneurysm that remains undetected until it ruptures. A rupture is very dangerous.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

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."

— Jerry, 68

"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."

— Abed, 60

3. 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.

More important

Equally important

More important

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.

More important

Equally important

More important

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.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. 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

Leaning toward

Undecided

Leaning toward

Credits

By	Healthwise Staff
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	David A. Szalay, MD - Vascular Surgery

References

Citations

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.
Eagle KA, Armstrong WF (2007). Disease of the aorta. In DC Dale, DD Federman, eds., ACP Medicine, section 1, chap. 12. New York: WebMD.
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.
Isselbacher EM (2008). Abdominal aortic aneurysms section of Diseases of the aorta. In P Libby et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed., pp. 1458–1469. Philadelphia: Saunders Elsevier.
U.S. Preventive Services Task Force (2005). Screening for Abdominal Aortic Aneurysm: Recommendation Statement (AHRQ Publication No. 05–0569-A). Rockville, MD: Agency for Healthcare Research and Quality. Also available online: http://www.ahrq.gov/clinic/uspstf/uspsaneu.htm.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

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Last Revised: February 4, 2011

Author: Healthwise Staff

Medical Review: Anne C. Poinier, MD - Internal Medicine & David A. Szalay, MD - Vascular Surgery

eMedicineHealth Medical Reference from Healthwise

This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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