AAA Screening for Nurse Practitioners | Primary Care Guide

 Abdominal aortic aneurysms (AAA) are often silent until they rupture—and rupture is almost always catastrophic. The good news: timely screening saves lives. As primary care providers, we’re in the best position to catch aneurysms early and prevent emergencies.

Who Should Be Screened?

• Men age 65–75 who have ever smoked
  → One-time abdominal ultrasound is recommended.

• Men age 65–75 who have never smoked
  → Consider screening on a case-by-case basis if there’s a family history of AAA.

• Women
  → Routine screening is not recommended. Only consider if high risk (family history, smoker, vascular disease).

Why It Matters

• AAA rupture has a mortality rate of ~80%.

• A quick, noninvasive abdominal ultrasound is highly sensitive and the gold standard for screening.

• Early detection allows for surveillance or referral to vascular surgery before the aneurysm grows to a dangerous size.

Management After Screening

• <3.0 cm → No aneurysm, no further follow-up.

• 3.0–3.9 cm → Small aneurysm → repeat ultrasound every 2–3 years.

• 4.0–5.4 cm → Medium aneurysm → monitor every 6–12 months.

• ≥5.5 cm or rapidly expanding → Surgical referral.

Clinical Pearls

• Ask about family history—first-degree relatives of patients with AAA are at increased risk.

• Always document smoking history; it’s the strongest modifiable risk factor.

• Many patients don’t realize screening is covered as a preventive service under Medicare (for eligible men).

• Keep an eye out for incidental findings—AAAs are sometimes spotted on imaging ordered for other reasons.

Takeaway for Busy NPs

AAA screening is quick, noninvasive, and life-saving. For eligible men, one ultrasound could be the difference between prevention and a catastrophic emergency.

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