Among the screening tests offered after 65, this one is easy to overlook. It is a single abdominal ultrasound, it takes a few minutes, it involves no needles or radiation, and for the right person it is done once in a lifetime. It looks for an abdominal aortic aneurysm, often shortened to AAA.

What an aortic aneurysm is

The aorta is the body’s main artery. It runs from the heart down through the chest and abdomen. An aneurysm is a bulge in a weakened section of its wall. The National Heart, Lung, and Blood Institute notes that the abdomen is the most common place for one to form, and that it can grow without causing any symptoms.

The Task Force defines an AAA as an aorta 3.0 centimeters across or larger. Most small aneurysms are simply watched. The concern is a large one, which can tear or rupture, a life-threatening emergency. Finding an aneurysm early means it can be measured over time and repaired before it reaches that point. In men, repair is generally considered at 5.5 centimeters or larger.

Who should be screened

The U.S. Preventive Services Task Force 2019 recommendation, still current as of October 2026, breaks it down by sex and smoking history:

  • Men aged 65 to 75 who have ever smoked: one-time ultrasound screening is recommended.
  • Men aged 65 to 75 who have never smoked: screening is offered selectively, based on medical history, family history, other risk factors and personal preference.
  • Women aged 65 to 75 who have ever smoked or have a family history of AAA: the evidence is not yet strong enough to recommend for or against.
  • Women who have never smoked and have no family history: routine screening is not recommended.

Smoking is the single biggest driver. In the trials the Task Force reviewed, screening men lowered deaths from AAA and the number of ruptures. It also led to more operations, which is part of why the advice is targeted rather than universal.

Other risk factors

The NHLBI lists several risk factors for AAA beyond age and smoking:

  • Family history. About 1 in 5 people with a parent, sibling or child who had an AAA will develop one.
  • Being male. Men develop AAA more often, though women who have one may rupture at a smaller size.
  • High blood pressure, high cholesterol and atherosclerosis, including coronary or peripheral artery disease.
  • COPD, obesity, and kidney disease, including chronic kidney disease and polycystic kidney disease.
  • Aneurysms elsewhere in the body.

Current smokers may also have aneurysms that grow faster. Quitting helps at any age.

Medicare coverage and what to expect

Medicare Part B covers a one-time AAA screening ultrasound for people at risk: anyone with a family history of AAA, or a man aged 65 to 75 who has smoked at least 100 cigarettes in his lifetime. You need a referral from your doctor. If the provider accepts Medicare assignment, there is usually no cost for the scan.

The test itself is simple. You lie on your back while a technician moves a probe over your abdomen. You may be asked to fast for a few hours beforehand so gas in the bowel does not blur the picture. If the aorta is normal size, most people never need the test again. If a small aneurysm is found, the usual plan is repeat imaging at set intervals and close attention to blood pressure, cholesterol and smoking.

Warning signs that need 911

A rupture is an emergency. The NHLBI describes the signs as sudden, severe pain in the stomach, chest or back, along with light-headedness and a rapid heart rate. If you or someone with you has these symptoms, call 911. Do not drive yourself to the hospital.

Because blood pressure and cholesterol both affect the aorta, our articles on home blood pressure monitoring and ApoB and lipoprotein(a) are useful companions to this one.

At Legacy Medical, Dr. Shtern reviews which screenings fit your age, smoking history and family history, writes the referral when the scan makes sense, and keeps track of any follow-up. Her Nephrology training means blood pressure and kidney health get close attention too. If you would like to meet her, the first visit is a complimentary meet and greet.

This article is general information, not advice for your situation. Members can call the office with questions about their own care.