The United States (U.S.) was home to both the first and the largest reported abdominal aortic aneurysm (AAA) screening programs to date. Influenced by the results of four randomized trials conducted outside the U.S., the U.S. Preventive Services Task Force (USPSTF) recommended one-time AAA screening with ultrasound for men 65-75 years old who have ever smoked. After the USPSTF report, the U.S. Congress added a Medicare benefit for free, one-time AAA screening with ultrasound for men who have smoked and for men and women with a family history of AAA. Screening may be underutilized in this target population, but recommendations by American vascular societies for much broader use of screening and repair than can be justified by the available evidence are influencing practice and threaten the effectiveness and cost-effectiveness of AAA screening in the U.S.