Advances in imaging and surveillance of AAA: when, how, how often?

Despite rapid technological developments for imaging the aorta, ultrasonography remains the method of choice for abdominal aortic aneurysm screening and surveillance. Randomised trials, conducted in the 20th century, have provided convincing evidence in favour of screening men at age 65 years, or older. However, in the 21st century the prevalence of aneurysms in 65 year old men has fallen by more than half, probably because of lower smoking prevalence and better cardiovascular risk prevention: screening or rescreening at an older age may be helpful. A recent meta-analysis has provided good evidence for surveillance intervals, with the majority of patients with screen-detected aneurysms (up to 4.5 cm diameter) being safely managed with 3-year surveillance intervals. Even for larger aneurysms, annual surveillance intervals are likely to be acceptable. This would reduce the number of surveillance visits by approximately half.