March 2005 | Vol. 23, No. 3

U.S. Preventive Services Task Force Recommends AAA Screening

The United States Preventive Services Task Force (USPSTF) recently issued a Final Recommendation regarding one-time screening for abdominal aortic aneurysms (AAA) by ultrasonography for men age 65 to 75 years who have ever smoked.

The USPSTF found “good” evidence that screening for AAA and surgical repair of large AAAs (5.5 cm or more) in men aged 65 to 75 who have ever smoked (current and former smokers) leads to decreased AAA-specific mortality. There is good evidence that abdominal ultrasonography, performed in a setting with adequate quality assurance (i.e., in an accredited facility with credentialed technologists), is an accurate screening test for AAA. There is also good evidence of important harms of screening and early treatment, including an increased number of surgeries with associated clinically-significant morbidity and mortality, and short-term psychological harms. Based on the moderate magnitude of net benefit, the USPSTF concluded that the benefits of screening for AAA in men aged 65 to 75 who have ever smoked outweigh the harms.

"Good" evidence is the highest of the Task Forces’ three levels of evidence. Good evidence means "evidence [of] ... consistent results from well-designed, well-conducted studies in representative populations that directly assess health effects on outcomes." The National Aneurysm Alliance (NAA), of which SVU is a member, said this USPSTF recommendation amounts to a very nice endorsement of AAA screening.

Unfortunately, the USPSTF made no recommendation for or against AAA screening for men age 65 to 75 years who have never smoked, and it recommended against routine screening for AAA in women.

Additional details on the USPSTF recommendation are available on the USPSTF website (www.preventiveservices.ahrq.gov).

Recently SVU has received some questions from members inquiring about what CPT code to use for Medicare reimbursement of AAA screenings. However, the recent U.S. Preventive Services Task Force (USPSTF) recommendation for AAA screening for all men between the ages of 65 and 75 that have ever smoked is just a recommendation and such policy has not yet been adopted by CMS, although the NAA is optimistic that it will be approved in the not too distant future. Check the SVU website and the e-Spectrum online member newsletter for the latest updates on this issue.