Abdominal Aortic Aneurysm

Overview

An abdominal aortic aneurysm (AAA) is a bulge or swelling in the aorta, the main blood vessel that runs from your heart down through your chest and belly. When the wall of this vessel weakens, it can balloon out, like a weak spot in a tire. If it grows too large, it may burst, which is dangerous. But when found early, most aneurysms can be safely monitored or treated.

It is not very common in the general population, but becomes more common with age, especially in men over 65 and people who smoke.

It mostly affects men over 65, but women, younger people, and those with a family history or certain connective tissue disorders can also develop it.

Symptoms

Common symptoms

• Most people have no symptoms at all.
• You may feel a pulsing sensation in your belly, like a heartbeat.
• A deep, constant pain in the belly or lower back is sometimes felt.

Symptoms in children

• AAA is extremely rare in children. This condition is generally an adult disease.

Symptoms in older adults

• Older adults may notice a dull ache or throbbing in the belly or back.
• Frequent bloating or a sense of fullness after eating can occur in some cases.

Causes

Main causes

• Weakness in the wall of the aorta, often linked to hardening of the arteries (atherosclerosis)
• High blood pressure that puts extra strain on the blood vessel wall
• Inflammation or damage to the artery wall

Risk factors

• Smoking or tobacco use
• High blood pressure
• High cholesterol
• Being male and over 65
• Having a family history of AAA
• Connective tissue disorders such as Marfan syndrome or Ehlers-Danlos syndrome

When to see a doctor

See a doctor urgently if:

• If you experience sudden, severe belly or back pain, fainting, or a weak pulse, call your local emergency number immediately.
• If you feel a large, throbbing lump in your belly, seek emergency care.
• If you have any symptoms of rupture, do not wait — this is a life-threatening emergency.

Book a routine appointment if:

• If you are over 65 and have ever smoked, ask your GP about an abdominal ultrasound screening.
• If you have a family history of AAA, discuss your risk with your doctor.
• If you have high blood pressure, high cholesterol, or another risk factor, book a routine check-up.

Diagnosis

AAA is usually detected with an ultrasound scan, which uses sound waves to create a picture of the aorta. It may be found during a screening appointment or by chance when you have a scan for another reason.

Tests that may be done

• Abdominal ultrasound — painless and quick, the main test used
• CT scan — sometimes needed to give a more detailed image and measure the aneurysm precisely

What to expect at your appointment

You will lie on a couch, and a small handheld probe will be moved over your belly with some gel. It feels like a standard pregnancy scan and usually takes about 15 minutes. There is no discomfort, and you can go home straight after.

Treatment

Treatment depends on the size of the aneurysm, how fast it is growing, and your overall health. Small aneurysms are usually monitored with regular ultrasound scans. Larger or fast-growing aneurysms may require surgery to prevent rupture.

Self-care at home

• Do not smoke — stopping is the single most effective step.
• Keep your blood pressure under control, as your doctor advises.
• Attend all your monitoring appointments to track the aneurysm size.
• Avoid heavy lifting or intense straining, which can raise pressure in the belly.

Medical treatments

Your doctor may prescribe medicines to lower blood pressure and cholesterol. Always take them exactly as recommended. No specific drug is named here because the right choice depends on your personal health.

When is surgery considered?

Surgery is usually recommended if the aneurysm is large (often more than 5.5 centimetres in diameter) or growing quickly. Two main procedures are used: open surgery to replace the weakened part of the aorta, or a less invasive endovascular repair using a stent (a small mesh tube) to reinforce the wall. Your vascular surgeon will explain which approach is best for you.

Living with this condition

With a small AAA, you can lead a normal, active life. Keep your check-up schedule, protect your general health, and talk to your doctor if you have any new symptoms. Most people feel fine and can continue their usual daily activities.

Lifestyle tips

• Quit smoking to slow the growth of the aneurysm.
• Stay active with gentle exercise like walking, swimming, or cycling.
• Avoid heavy weightlifting or activities that involve straining with a closed breath.
• Manage stress with relaxation, meditation, or simply taking time for yourself.

Diet and exercise

Eat a heart-healthy diet rich in vegetables, fruits, whole grains, and lean protein. Reduce salt and processed foods. Aim for regular, moderate exercise, but check with your doctor before starting a new intense routine.

Mental health and emotional wellbeing

Knowing you have an aneurysm can feel frightening and cause anxiety. It is normal to worry. Talk to your healthcare team about your concerns, and seek emotional support from family, friends, or a counsellor if needed.

Prevention

You cannot always prevent an AAA, but you can lower your risk. The most important steps are not smoking, keeping blood pressure and cholesterol normal, and staying physically active.

Vaccines

There is no vaccine for AAA, but staying up to date with recommended vaccinations, such as flu and pneumococcal vaccines, helps protect your overall health and reduce stress on your body.

Screening programmes

In the UK, men are invited for a one-time ultrasound screening in the year they turn 65. If you have risk factors like a family history, ask your GP about your own screening options.

Complications

If left untreated

• The most dangerous risk is rupture, which causes life-threatening internal bleeding.
• A blood clot may form in the aneurysm and block blood flow to your legs or other organs.
• The aneurysm can become inflamed or press on nearby structures, causing pain.

Long-term outlook

With early detection and proper management, the outlook is very good. Small aneurysms often never cause problems. Even larger ones can be treated safely with planned surgery. Rupture is an emergency, but if you get help immediately, many people survive and recover well.

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