Optimizing Abdominal Aortic Aneurysm Imaging to Improve Access, Clinical Utility, and Value-Based Medicine

Abdominal aortic aneurysm (AAA) care relies on imaging for screening, surveillance, prerepair planning, and postrepair follow-up, yet both overuse and underuse can harm patients and inflate costs. We performed a narrative synthesis of contemporary guidelines and primary studies to outline a value-based pathway that emphasizes clinical safety, equity, and resource stewardship. Evidence supports an ultrasound-first strategy for unrepaired AAAs, targeted 1-time ultrasound screening in at-risk populations, and a single computed tomography angiogram (CTA) before repair to define anatomy and device planning. After endovascular aneurysm repair (EVAR), routine follow-up can be centered on duplex ultrasonography (DUS) ± contrast-enhanced ultrasound (CEUS), reserving computed tomography angiogram (CTA)/MRA for sac growth, suspected endoleak, or complex repairs. Implementation levers include guideline-embedded order sets, automated capture of incidental AAAs, and operational steps that improve access for disadvantaged patients. In conclusion, a risk-adapted, ultrasound-lean imaging strategy preserves outcomes while lowering cumulative radiation exposure, reducing expenditures, and improving access, thereby advancing value-based cardiovascular care.