Why are men offered screening for abdominal aortic aneurysms?

Photo of an elderly man on a walk

Abdominal aortic aneurysms are more common in men over the age of 65 than in other groups of people. That's why they are offered for this condition. Screening lowers the risk of the aneurysm rupturing (bursting open) and leading to death. But treatment can lead to serious complications.

Abdominal aortic aneurysms rarely rupture, but it’s a life-threatening medical emergency if they do. Screening for abdominal aortic aneurysms can be a good idea in men over the age of 65. It is done to discover larger aneurysms so that they can be operated on in order to prevent a rupture. Smaller bulges in the vessel are monitored on a regular basis to see whether they get larger.

But has disadvantages, too: Some of the aneurysms that are detected would never have caused any health problems. Knowing that you have an aneurysm can also be very distressing.

What does the screening tell us?

In the screening examination, ultrasound is used to measure the diameter (width) of the abdominal aorta. The next steps are determined by the results of this measurement.

If 1,000 men aged 65 and over are screened, we can expect the following results:

  • About 980 of the 1,000 men will not have an aneurysm: Their aortas will all have a diameter of less than 3 cm (1.18 inches). This is considered to be a "normal" size.
  • About 18 of the 1,000 men will have a small to medium-sized aneurysm: If the abdominal aorta is 3 to 5.4 cm (1.18 to 2.12 inches) in diameter, experts recommend that it is monitored regularly using ultrasound. If it gets bigger, surgery may be a good idea later on.
  • About 2 of the 1,000 men will have a large aneurysm: If the diameter is 5.5 cm (2.16 inches) or more, the risk of rupture is relatively high. Surgery is usually recommended in these cases.

The following illustration shows the expected results of described above.

Illustration: What happens if 1,000 men aged 65 and over have screening?


  • even if the results are normal, an aneurysm may still develop later on.
  • Some of the aneurysms that are discovered would never have caused any health problems.

What are the advantages of screening?

Especially if the aneurysm is large, there is a risk that it will unexpectedly rupture within the next few years. Screening can help to prevent a rupture that causes life-threatening blood loss.

Studies have looked into how many ruptures and deaths can be avoided by detecting aneurysms early on. The following estimate shows what men aged 65 and over can generally expect during the 13 years following with ultrasound:

  Rupture of an aneurysm Death from an aneurysm
Without About 7 out of 1,000 About 6 out of 1,000
With About 4 out of 1,000 About 3 out of 1,000
This means that a ruptured aneurysm will be prevented in about 3 out of 1,000 people. death from an aneurysm will be prevented in about 3 out of 1,000 people.

What are the disadvantages of screening?

Some of the aneurysms found during the scan would have gone unnoticed if it hadn't been for the . They wouldn't have ruptured, and check-ups or surgery wouldn't have been necessary. Unfortunately, it's not always possible to tell the difference between harmless aneurysms and dangerous ones.

It is estimated that about half of the aneurysms that are found remain harmless – particularly the small aneurysms. In other words,

about 20 out of the 1,000 men who have find out that they have an aneurysm. But the aneurysm would never have caused any trouble in about 10 of them.

What changes when you know you have an aneurysm?

The can stir up very different and sometimes mixed emotions. Some men are glad that their aneurysm was discovered – the check-ups make them feel safe.

Other men wish they hadn't found out about it. Knowing about it can be scary and worrying.

Many men go on living with the feeling that their lives are in danger. Things like abdominal pain can then be unsettling. And many men stop doing certain things in everyday life out of fear that the aneurysm could rupture. They become more cautious and avoid physical exertion.

What happens during surgery?

If a large aneurysm is discovered during a examination, surgery could be an option. Preventive surgery can be done in two ways:

  • The aneurysm is opened and replaced with an artificial blood vessel. To do this, the surgeon needs to cut through the wall of the abdomen (belly).
  • A tube is implanted in the aneurysm. This procedure involves making a small cut in the groin. The tube is inserted through the cut and into the aorta using a , and pushed through to where the aneurysm is.

Both of these procedures can save lives. But they can also cause serious complications, such as a heart attack, a stroke, a lung infection, or an of the artificial blood vessel or nearby tissue.

So it's important to carefully consider whether the risk of the aneurysm rupturing is big enough to justify having surgery. The decision about whether or not to have surgery will also depend on the man's general health and how he views the pros and cons of surgery himself.

Does screening have more benefits or more drawbacks?

Different men draw different conclusions about the pros and cons of . Some want to have because they consider it to have more benefits, whereas others decide against it because they see more drawbacks. A decision aid may help you to figure out how you feel about the pros and cons of for an abdominal aortic aneurysm. It can help you to determine what is important to you and what you would like to know more about. It can also be useful when preparing to have a talk with the doctor.

Ali MU, Fitzpatrick-Lewis D, Kenny M et al. A systematic review of short-term vs long-term effectiveness of one-time abdominal aortic aneurysm screening in men with ultrasound. J Vasc Surg 2018; 68(2): 612-623.

Guirguis-Blake JM, Beil TL, Senger CA et al. Primary Care Screening for Abdominal Aortic Aneurysm: A Systematic Evidence Review for the U.S. Preventive Services Task Force. (AHRQ Evidence Syntheses; No. 184). 2019.

Guirguis-Blake JM, Beil TL, Senger CA et al. Primary Care Screening for Abdominal Aortic Aneurysm: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2019; 322(22): 2219-2238.

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Ultrasound screening for abdominal aortic aneurysms: Final report; commission S13-04. 2015.

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Information for health insurance fund members on ultrasound screening for abdominal aortic aneurysms – addendum to commission S13-04: commission P16-01. 2016.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on October 6, 2021

Next planned update: 2024


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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