Targeted Detection of Abdominal Aortic Aneurysm in Primary Care: Who to Screen, How to Screen, and What to Do Next

Background Screening‐detected abdominal aortic aneurysm (AAA) has fallen in contemporary cohorts. The 2024 European Society for Vascular Surgery recommends screening high‐risk populations but leaves country‐specific definitions to reflect local epidemiology and system factors. This places greater responsibility on primary care to recognize risk and trigger appropriate screening. Purpose To provide a concise, family medicine‐facing review of who to screen, how to screen, and what to do after screening, with pragmatic tools for rapid implementation. Sources of Information Major guideline statements and national program documents, alongside recent population data on screening yields. Findings Routine population screening is less compelling as yields decline. One‐time ultrasound remains appropriate for men aged 65–75 who have ever smoked, while never‐smokers warrant selective offers based on risk and preferences. Average‐risk women should not be screened routinely. Targeted case‐finding is reasonable for first‐degree relatives, patients with other peripheral aneurysms, and solid organ transplant recipients. Countries should define additional high‐risk groups locally. A simple primary‐care pathway that maps diameter bands to surveillance intervals and referral thresholds aligns practice with specialist care. Implications for Practice Embed electronic record prompts (where available) for age, ever‐smoking, family history, peripheral aneurysm history, and transplant status; agree local pathways with vascular services, especially where national programs or “high‐risk” lists are absent; and screen only when life expectancy and fitness for repair make benefit plausible (e.g., avoid screening where advanced comorbidity implies limited life expectancy). Conclusions In 2025, AAA screening belongs to targeted, locally defined strategies led by primary care, not blanket population screening.