Abdominal aortic aneurysm is becoming less common in routine population screening, but prevalence remains sharply concentrated in older male smokers, first-degree relatives, and patients with vascular or cardiopulmonary disease. This review maps where AAA is now rare, where it is still unexpectedly frequent, and why future screening may need to become more targeted than universal.
Human-verified editorial review
Verified by World ID proof-of-human. This editorial layer was submitted from a SAIMSARA account verified as a unique human.
Abstract: To synthesize current evidence on the prevalence of abdominal aortic aneurysm (AAA) across diverse populations, clinical settings, and risk groups based on recent cohort and cross-sectional studies. The review utilises 419 original studies with 6230192 total participants (topic deduplicated ΣN). The mapped evidence indicates that contemporary AAA prevalence in screened 65-year-old men clusters around a median of 1.5% (range 1.32%–2.6%), with consistently lower rates in women (median 0.5%, range 0%–1.3%) and a clear declining trend over recent decades, exemplified by reductions from 5.0% in 1991 to 1.3% in 2015 in long-running programmes. Across the topic synthesis, prevalence was strongly modulated by smoking, advancing age, male sex, and family history, with brothers of affected individuals reaching lifetime estimates as high as 32% and peripheral artery disease cohorts approaching 13%. Recurrent signals also support elevated yields in chronic obstructive pulmonary disease, coronary artery disease, inguinal hernia, and cerebrovascular disease populations, alongside an apparently inverse association with diabetes mellitus that warrants mechanistic exploration. The evidence map further highlights substantial geographic and ethnic heterogeneity, with lower prevalence in Asian populations and notably higher burden in New Zealand Māori, suggesting that universal one-size-fits-all screening thresholds may be suboptimal. Clinically, these signals support a shift toward risk-factor-targeted and opportunistic screening embedded within cardiology, primary care, and incidental imaging workflows rather than reliance on age- and sex-based invitation alone. Future research should prioritise prospective validation of risk-stratified screening models incorporating smoking, family history, comorbidity, and body-size-adjusted aortic indices, particularly in women and underrepresented non-Western populations, to refine equitable and cost-effective surveillance strategies in an era of declining background prevalence.
Final search date and database lock: 2026-05-01 20:57:25 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 1013
Downloaded Abstracts/Papers: 1013
Included original and non-original Abstracts/Papers (all): 480
Included original Abstracts/Papers (Vote counting by direction of effect): 419
Reference Index (links used in paper): 167
Total participants (topic deduplicated ΣN): 6230192
Get access to the full paper
Unlock the full evidence map
The full evidence review, including the Introduction, Methods, Results, Discussion, Conclusion, figures, and complete reference index, opens after purchase or sign-in.
The Evidence Object JSON is a separate machine-readable evidence product: a concentrated synthesis of results, topic-level evidence, and discussion across original and non-original studies. It can be directly input into your LLM, agent, or RAG workflow.
[17] Screening of Abdominal Aortic Aneurysm Using Portable Transthoracic Echocardiography among Patients with Acute Coronary Syndrome. — https://doi.org/10.1155/2020/9510546
[23] Extending Abdominal Aortic Aneurysm Detection to Older Age Groups: Preliminary Results from the Liège Screening Programme. — https://doi.org/10.1016/j.avsg.2016.02.034
[33] Prevalence of Intracranial Aneurysms in Patients with Infrarenal Abdominal Aortic Aneurysms: A Multicenter Experience. — https://doi.org/10.1055/s-0040-1713139
[62] High prevalence of abdominal aortic aneurysm in older men with cerebrovascular disease: Evaluation of a local screening program. — https://doi.org/10.3389/fneur.2023.1131322
[69] Comparison of three targeted approaches to screening for abdominal aortic aneurysm based on cardiovascular risk. — https://doi.org/10.1002/bjs.10224
[70] Meta-analysis of the current prevalence of screen-detected abdominal aortic aneurysm in women. — https://doi.org/10.1002/bjs.10225
[79] Superior Reproducibility of the Leading to Leading Edge and Inner to Inner Edge Methods in the Ultrasound Assessment of Maximum Abdominal Aortic Diameter. — https://doi.org/10.1016/j.ejvs.2017.11.019
[88] Revisiting the cost-effectiveness of screening 65-year-old men for abdominal aortic aneurysm based on data from an implemented screening programme. — https://doi.org/10.23736/s0392-9590.16.03777-9
[96] Prevalence of Abdominal Aortic Aneurysms in the General Population and in Subgroups at High Cardiovascular Risk in Italy. Results of the RoCAV Population Based Study. — https://doi.org/10.1016/j.ejvs.2018.01.008
[97] Sexual Dimorphism in Abdominal Aortic Aneurysm-Insights from Clinical and Experimental Studies. — https://doi.org/10.3390/jvd4010005
[123] Multicenter investigations of the prevalence of abdominal aortic aneurysm in elderly Japanese patients with hypertension. — https://doi.org/10.1253/circj.cj-14-0972
[132] Early Detection of Undiagnosed Abdominal Aortic Aneurysm and Sub-Aneurysmal Aortic Dilatations in Patients with High-Risk Coronary Artery Disease: The Value of Targetted Screening Programme. — https://doi.org/10.2147/vhrm.s250735
[134] Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study : The Tromsø Study. — https://doi.org/10.1093/aje/154.3.236
[137] Prevalence of abdominal aortic aneurysm (AAA) in a population undergoing computed tomography colonography in Canterbury, New Zealand. — https://doi.org/10.1016/j.ejvs.2015.04.023
[144] Gender-specific Predicted Normal Aortic Size and Its Consequences of the Population-Based Prevalence of Abdominal Aortic Aneurysms. — https://doi.org/10.1016/j.avsg.2022.11.025
[149] Screening for abdominal aortic aneurysm in 65-year-old men remains cost-effective with contemporary epidemiology and management. — https://doi.org/10.1016/j.ejvs.2013.12.023
[157] Prevalence of abdominal aortic aneurysm and large infrarenal aorta in patients with acute coronary syndrome and proven coronary stenosis: a prospective monocenter study. — https://doi.org/10.1016/j.avsg.2009.12.010
[158] Screening Men and Women above the Age of 50 Years for Abdominal Aortic Aneurysm: A Pilot Study in an Upper Middle Income Country. — https://doi.org/10.1016/j.ejvs.2024.03.003
[160] Screening for abdominal aortic aneurysm and occlusive peripheral vascular disease in Japanese residents. — https://doi.org/10.1007/bf00311434
[171] Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group. — https://doi.org/10.7326/0003-4819-126-6-199703150-00004
[172] High prevalence of abdominal aortic aneurysms in brothers and sisters of patients despite a low prevalence in the population. — https://doi.org/10.1016/j.jvs.2012.01.061
[173] Increased prevalence of abdominal aortic aneurysm in patients undergoing inguinal hernia repair compared with patients without hernia receiving aneurysm screening. — https://doi.org/10.1016/j.jvs.2010.11.053
[181] A retrospective cohort study of incidental abdominal aortic aneurysms on routine abdominal computed tomography scans in Te Tairāwhiti (2018-2019). — https://doi.org/10.26635/6965.6365
[182] Optimising Abdominal Aortic Aneurysm Screening of 65 Year Old Men by Exploring Risk Factor Based Targeted Screening Strategies in the Light of Declining Prevalence of the Disease. — https://doi.org/10.1016/j.ejvs.2024.10.005
[183] Popliteal Aneurysms are Common Among Men With Screening Detected Abdominal Aortic Aneurysms, and Prevalence Correlates With the Diameters of the Common Iliac Arteries. — https://doi.org/10.1016/j.ejvs.2019.07.042
[190] Editor's Choice - Inequalities in Abdominal Aortic Aneurysm Screening in England: Effects of Social Deprivation and Ethnicity. — https://doi.org/10.1016/j.ejvs.2017.03.006
[192] Advanced complicated diabetes mellitus is associated with a reduced risk of thoracic and abdominal aortic aneurysm rupture: a population-based cohort study. — https://doi.org/10.1002/dmrr.2585
[195] Prevalence and predictors of coexistent silent atherosclerotic cardiovascular disease in patients with abdominal aortic aneurysm without previous symptomatic cardiovascular diseases. — https://doi.org/10.1177/0003319711419359
[197] Prevalence of Thoracic Aortic Aneurysms in Patients with Degenerative Abdominal Aortic Aneurysms: Results from the Prospective ACTA Study. — https://doi.org/10.1016/j.ejvs.2021.03.004
[199] Prevalence of the metabolic syndrome in patients with coronary heart disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm. — https://doi.org/10.1016/j.atherosclerosis.2003.12.033
[207] Measuring abdominal aortic diameters in routine abdominal computed tomography scans and implications for abdominal aortic aneurysm screening. — https://doi.org/10.1016/j.jvs.2016.11.044
[212] Prevalence of risk factors and of coronary artery disease, ischemic stroke, carotid arterial disease and lower extremity peripheral arterial disease in 96 patients undergoing elective surgery for an abdominal aortic aneurysm. — https://doi.org/10.1055/s-0031-1278298
[213] Ruptured: Retrospective Analysis Undertaken for Patients Treated for Unexplained Retroperitoneal or Abdominal Pain in the Emergency Department. — https://doi.org/10.12968/hmed.2024.0357
[215] Prevalence of coronary artery disease, lower extremity peripheral arterial disease, and cerebrovascular disease in 110 men with an abdominal aortic aneurysm. — https://doi.org/10.1016/j.amjcard.2004.07.136
[219] Multiple sites of vascular dilation or aneurysmal disease and matrix metalloproteinase genetic variants in patients with abdominal aortic aneurysm. — https://doi.org/10.1016/j.jvs.2017.09.047
[224] A comparative study of the prevalence of abdominal aortic aneurysms in the United Kingdom, Denmark, and Australia. — https://doi.org/10.1136/jms.8.1.46
[228] [Validity of the abdominal ecography in primary care for detection of aorta abdominal aneurism in male between 65 and 75 years]. — https://doi.org/10.1016/j.aprim.2017.10.005
[229] The lifetime prevalence of abdominal aortic aneurysms among siblings of aneurysm patients is eightfold higher than among siblings of spouses: an analysis of 187 aneurysm families in Nova Scotia, Canada. — https://doi.org/10.1016/j.jvs.2005.08.002
[235] Screening for abdominal aortic aneurysms during a basic medical checkup in residents of a Japanese rural community. — https://doi.org/10.1007/s005950070098
[241] Coronary arterial ectasia: increased prevalence in patients with abdominal aortic aneurysm as compared to occlusive atherosclerotic peripheral vascular disease. — https://doi.org/10.1016/0002-8703(93)90060-m
[243] Screening results from a large United Kingdom abdominal aortic aneurysm screening center in the context of optimizing United Kingdom National Abdominal Aortic Aneurysm Screening Programme protocols. — https://doi.org/10.1016/j.jvs.2015.08.091
[244] Ultrasound Screening of Men with Coronary Artery Disease for Abdominal Aortic Aneurysms: A Prospective Dual Center Study. — https://doi.org/10.1177/1457496915626839
[248] [Feasibility of hand-held-ultrasonography in the screening of abdominal aortic aneurysms and abdominal aortic atherosclerosis]. — https://doi.org/10.1016/j.medcli.2013.02.038
[254] Abdominal aortic diameter is increased in males with a family history of abdominal aortic aneurysms: results from the Danish VIVA-trial. — https://doi.org/10.1016/j.ejvs.2014.09.005
[256] Prevalence of aortoiliac aneurysms in solid organ transplant recipients using the National Inpatient Sample database. — https://doi.org/10.1016/j.jvs.2024.12.042
[266] Screening cardiovascular patients for aortic aneurysms (SCAN) – high prevalence of abdominal aortic aneurysms in coronary heart disease patients requiring intervention. — https://doi.org/10.1024/0301-1526/a000881
[268] Editor's Choice - The Prevalence of Abdominal Aortic Aneurysm in First Degree Relatives: A Systematic Review and Meta-analysis. — https://doi.org/10.1016/j.ejvs.2025.12.044
[271] Aortic aneurysm screening in a high-risk population: a non-contrast computed tomography study in korean males with hypertension. — https://doi.org/10.4070/kcj.2014.44.3.162
[278] Prevalence and Prediction of Aneurysmal Dilatation of the Abdominal Aorta in Koreans: Results of Screening During Transthoracic Echocardiographic Examination. — https://doi.org/10.4250/jcvi.2020.0034
[298] The importance of socioeconomic factors for compliance and outcome at screening for abdominal aortic aneurysm in 65-year-old men. — https://doi.org/10.1016/j.jvs.2012.12.080
[299] Editor's choice: five-year outcomes in men screened for abdominal aortic aneurysm at 65 years of age: a population-based cohort study. — https://doi.org/10.1016/j.ejvs.2013.10.007
[309] Lessons learned about prevalence and growth rates of abdominal aortic aneurysms from a 25-year ultrasound population screening programme. — https://doi.org/10.1002/bjs.10715
[317] Routine screening for asymptomatic abdominal aortic aneurysm in high-risk patients is not recommended in emergency departments that are frequently crowded. — https://doi.org/10.1111/j.1553-2712.2009.00502.x
[323] Family members of patients with abdominal aortic aneurysms are at increased risk for aneurysms: analysis of 618 probands and their families from the Liège AAA Family Study. — https://doi.org/10.1016/j.avsg.2013.11.005
[325] Screening women aged 65 years or over for abdominal aortic aneurysm: a modelling study and health economic evaluation. — https://doi.org/10.3310/hta22430
[326] The metabolic syndrome is associated with advanced vascular damage in patients with coronary heart disease, stroke, peripheral arterial disease or abdominal aortic aneurysm. — https://doi.org/10.1016/j.ehj.2003.12.007
[327] KDIGO 2025 Clinical Practice Guideline for ADPKD: a commentary on intracranial aneurysms and other vascular manifestations from the ERA Working Group Genes & Kidney. — https://doi.org/10.1093/ndt/gfag096
[328] Screening for abdominal aortic aneurysm in coronary care unit patients with acute myocardial infarction using portable transthoracic echocardiography. — https://doi.org/10.1093/ejechocard/jer260
[346] Decreasing aortic diameter and decreasing prevalence of infrarenal aortic aneurysms in a population-based screening programme. — https://doi.org/10.1093/bjs/znaf156
[359] The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. — https://doi.org/10.1001/archinte.160.10.1425
[368] Incidental diagnosis and reporting rate of abdominal aortic aneurysms on lumbar spine magnetic resonance imaging. — https://doi.org/10.21037/qims-24-1291
[372] The Fate of Patients Opportunistically Screened for Abdominal Aortic Aneurysms During Echocardiogram or Arterial Duplex Scans. — https://doi.org/10.1016/j.ejvs.2023.05.042
[373] A systematic review of short-term vs long-term effectiveness of one-time abdominal aortic aneurysm screening in men with ultrasound. — https://doi.org/10.1016/j.jvs.2018.03.411
[376] High-risk and low-risk screening for abdominal aortic aneurysm both reduce aneurysm-related mortality. A stratified analysis from a single-centre randomised screening trial. — https://doi.org/10.1016/j.ejvs.2006.12.031
[377] The association between diabetes and abdominal aortic aneurysms in men: results of two Danish screening studies, a systematic review, and a meta-analysis of population-based screening studies. — https://doi.org/10.1186/s12872-023-03160-8
[460] Metabolic syndrome is an independent predictor of cardiovascular events in high-risk patients with occlusive and aneurysmatic peripheral arterial disease. — https://doi.org/10.1016/j.atherosclerosis.2009.12.018
