The U.S. Preventive Services Task Force (USPSTF) has reaffirmed with no major changes its 2014 recommendations on using ultrasound to screen for asymptomatic abdominal aortic aneurysm (AAA), in a new statement published online December 10 in the Journal of the American Medical Association.
After consideration of public comments on its draft recommendation statement, the USPSTF has finalized its guidance on AAA screening, which reaffirms the task force's 2014 recommendations with no substantial changes. The 2019 guidance for ultrasound AAA screening includes the following recommendations:
- One-time screening for male ever-smokers ages 65 to 75 (B grade)
- Selective screening for male nonsmokers ages 65 to 75 (C grade)
- No screening for female nonsmokers ages 65 to 75 without a family history of AAA (D grade)
- No recommendation for female smokers ages 65 to 75 with a family history of AAA due to insufficient evidence (I grade)
The group's evidence report was based on a review of 50 studies published through September 2018 that examined the potential harms and benefits of ultrasound AAA screening in roughly 320,000 individuals.
Collectively, results from the clinical trials showed that AAA screening in men 65 years or older was associated with reductions in AAA-related ruptures (odds ratio, 0.62), AAA-related death (odds ratio of 0.65), and emergency surgical procedures (odds ratio, 0.57) within the first 15 years after initial screening.
One-time screening also led to statistically significant increases in the total number of procedures performed per individual (odds ratio, 1.44). However, surgical treatment did not result in statistically significant reductions in AAA-related mortality or all-cause mortality within the first 12 years after initial screening, compared with surveillance alone.
Thus, although ultrasound AAA screening offered clear benefits for reducing AAA-related deaths in certain populations, the increase in elective surgeries in no way resolved the question of all-cause mortality, the task force noted.
The current USPSTF recommendations underscore a major gap in AAA screening -- a lack of evidence concerning the prevalence and potential benefits of screening among individuals, especially women and underserved populations, who smoke and have a family history of AAA, Dr. Julie Ann Freischlag from Wake Forest Baptist Medical Center noted in an accompanying editorial.
"More information is needed about the prevalence and growth rates of AAA in men and women with diverse backgrounds so that care -- including screening, follow-up, and treatment -- can be individualized, and outcomes for patients with AAA can be improved," she wrote.
In a separate editorial published in JAMA Network Open, Dr. Matthew Mell from the University of California, Davis pointed out that the Society for Vascular Surgery and other organizations recommend more liberal use of AAA screening to identify a broader group of individuals who may benefit from the exam.
"More research is needed to optimize diffusion of current recommendations and to identify other patient cohorts with a high pretest probability of AAA and who benefit from repair and therefore screening," he wrote.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
