The Health Information and Quality Authority has today published a health technology assessment (HTA) of screening for abdominal aortic aneurysm (AAA or ‘triple A’) in men, following a public consultation that took place earlier this year.

HIQA completed this assessment at the request of the National Screening Advisory Committee (NSAC) to help inform its decision on whether to introduce an AAA screening programme for men in Ireland.

An AAA is a swelling or ballooning of the abdominal section of the aorta, the largest blood vessel in the body. If an AAA bursts (ruptures), it typically results in life-threatening internal bleeding, which is usually fatal. An AAA often shows no symptoms before rupture. Early detection reduces the risk of dying from an AAA rupture. This HTA specifically evaluated population-based ultrasound AAA screening for men, given the higher prevalence of the condition among this group.

The assessment found that AAA prevalence and rupture rates in men are declining internationally, and the available evidence suggests these rates will continue to decline. It is estimated that approximately 1% of men aged 65 years have an AAA, based on data from the UK NHS AAA screening programme. Although the benefit-harm balance still favours screening, the clinical and economic benefits of population-based screening are decreasing over time as the number of people with an AAA declines.

Dr Máirín Ryan, HIQA's Deputy CEO and Director of Health Technology Assessment, said: “It is important that resources are directed towards areas that can deliver the greatest benefits to overall population health.” Dr Ryan continued: “As the number of people with an AAA falls, the resources needed to establish and maintain a formal screening programme must be weighed against other healthcare interventions that may need to be delayed, scaled back or deprioritised to make AAA screening possible.”

The assessment also identified several constraints within the current AAA clinical care pathway, including capacity shortages in vascular and radiology services, as well as limitations in data availability and ICT infrastructure. Dr Ryan added: “Information on the number of AAAs detected in Ireland is limited, making it difficult to determine the difference that screening would likely make. Having said that, the evidence shows that most AAA admissions to Irish public hospitals are planned, suggesting that many AAAs are being identified without a formal screening programme.”

Ends.

For further information please contact:

Caoimhe O’Connell, Communications Manager 087 639 5916 / caoconnell@hiqa.ie 

Notes to the editor:

• The Health Information and Quality Authority (HIQA) has today published the following documents:
  • Health technology assessment of abdominal aortic aneurysm (AAA) screening for men.
  • Statement of outcomes of the public consultation for this HTA.
• The National Screening Advisory Committee (NSAC) was established in 2019 as an independent advisory committee to advise the Minister for Health and Department of Health on all new proposals for population-based screening programmes and revisions to existing programmes. Further information on the NSAC is available here.
• HIQA was requested by the Department of Health to provide evidence synthesis support and evidence-based advice to the NSAC under an agreed work programme.
• The aim of screening is to identify people in an apparently healthy population with pre-clinical or asymptomatic disease so that early treatment can be offered, where appropriate.
• The HTA was informed by a public and targeted consultation, which ran for six weeks from 1 May to 12 June 2025. Details of the consultation process are provided in the associated statement of outcomes report, also published on the HIQA website.
• Currently, in the absence of a national AAA screening programme in Ireland, people with an AAA are usually identified during imaging for other indications.
• Ultrasound is the recommended imaging modality for diagnosis, screening, and surveillance of small AAAs.
• An AAA is typically defined as an aortic diameter of 3 cm or more. In most men, the normal diameter of the abdominal aorta is approximately 2 cm.
• Smoking is considered the strongest modifiable risk factor for AAA development. The decline in AAA prevalence over time is primarily attributed to decreased smoking rates, as well as improvements in cardiovascular risk factor management.
• Screening may lead to overdiagnosis - the detection of a disease or condition that would never have produced symptoms or problems if undiagnosed. The possible outcomes of overdiagnosis are significant, including potential psychological effects, potential treatment-related adverse events, and wasted resources.