Screening

Routine screening for AAA for all men aged 65 years and over has been available in the UK since 2013, and in England since 2009.[89] Screening significantly reduces AAA-specific mortality in this population.[90][91][92]​​[93]

  • Men are automatically invited for screening in the year they turn age 65.

  • Men who are older than age 65 and who have not previously been screened can opt in through self-referral direct to the screening programme.

  • Men who have previously been treated for an AAA are excluded from screening.

Aortic diameter at the screening appointment determines the subsequent management pathway. The UK AAA screening programme recommends the following surveillance intervals:[3][42]​​​​[92]​​[94]

Aortic diameter (anterior-posterior, inner to inner)

Re-scanning interval

<3 cm

Discharged from programme

3 to 4.4 cm

Annual surveillance programme

4.5 to 5.4 cm

3-monthly surveillance programme

>5.5 cm

Referral to vascular surgeon

Re-scanning intervals associated with aortic diameters[94]

Meta-analysis of AAA surveillance studies and randomised control trials suggests that longer surveillance intervals than those currently employed in the UK AAA screening programme could be safely implemented, thereby reducing cost.[95][96][97]​​

There is insufficient evidence to assess the balance of benefits and harms of one-time AAA population screening for women.[3][4]​​​[98][99]

  • The European Society for Vascular Surgery (ESVS) recommends that AAA screening should be considered for high-risk populations.[3] However, the definition of ‘high-risk’ varies and you should check local guidelines.[3]

  • The ESVS recommends incorporation of subaneurysmal aortas (2.5 to 2.9 cm) into AAA surveillance recommendations because long-term cohort studies show that most subaneurysmal aortas eventually progress to an AAA of which a substantial proportion will reach the diameter threshold for consideration of repair.[3] Surveillance decisions should take into account life expectancy, suitability for future repair, and patient preferences.[3]

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