Abdominal Aortic Aneurysm Screening

Overview

Your aorta is the main blood vessel that carries blood from your heart to the rest of your body. It runs through your chest and abdomen. An abdominal aortic aneurysm (AAA) is a bulge in the part of the aorta that passes through your belly. Screening is a simple scan that looks for this bulge before it causes any symptoms. It helps detect a potential problem early, when it can be monitored or treated more safely.

It’s not very common, but the risk rises with age. In the UK, about 1 in 50 men over 65 have an AAA. It is less common in women, but it can still happen.

It mainly affects men aged 65 and older, especially smokers or ex-smokers. You are also more at risk if you have high blood pressure, a family history of AAA, or a history of heart or blood vessel disease.

Symptoms

Common symptoms

• Most people with an AAA have no symptoms at all.
• Sometimes, there may be a pulsing feeling in your belly, or a deep pain in your abdomen or lower back.
• These symptoms are not specific, so they are easy to mistake for less serious conditions.

Symptoms in children

• Abdominal aortic aneurysms do not affect children. This condition is only seen in older adults.

Symptoms in older adults

• Many older adults with an AAA have no symptoms and only find out about it through screening.
• If symptoms do appear, they may include a constant, deep belly or back pain, or a noticeable pulse near the belly button.

Causes

Main causes

• The wall of the aorta becomes weak and bulges outwards.
• Atherosclerosis – a build-up of fatty deposits inside the arteries – is a common underlying cause.
• High blood pressure can put extra strain on the aortic wall.

Risk factors

• Being male and aged 65 or older.
• Smoking – the strongest lifestyle risk factor.
• High blood pressure.
• Having a family history of AAA.
• Having atherosclerosis or other heart and blood vessel conditions.

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe pain in your belly or lower back, especially with dizziness or fainting, call your local emergency number straight away.
• If you have a known AAA and develop new pain, seek urgent medical help.

Book a routine appointment if:

• If you are a man aged 65 or older, ask your GP about screening.
• If you have a family history of AAA, talk to your GP about whether you should be screened earlier.
• If you are a woman with risk factors such as smoking or high blood pressure, ask your GP if screening is advisable.

Diagnosis

The main test is an abdominal ultrasound scan. This uses sound waves to create a picture of your aorta. If an aneurysm is found, your doctor may order a CT scan to get a more detailed image and measure it more accurately.

Tests that may be done

• Abdominal ultrasound – the standard screening test.
• CT scan – used for more detailed imaging if an aneurysm is found.
• Periodic repeat scans – to watch for growth.

What to expect at your appointment

You will be asked to lie down on a couch. A warm gel is spread on your abdomen, and a small hand-held probe is moved gently across your skin. You will feel a little pressure but no pain. The whole scan takes about 10–15 minutes. You can go back to your normal routine immediately after.

Treatment

Treatment for an AAA depends on its size, how fast it is growing, and your overall health. Small aneurysms are usually monitored with regular scans. Large or fast-growing ones may need surgery to repair the wall of the aorta and prevent it from rupturing.

Self-care at home

• Keep all your follow-up scan appointments.
• Stop smoking if you smoke.
• Keep your blood pressure under control – your GP can help you with a plan.
• Eat a balanced diet and stay as active as you comfortably can.
• Talk to your doctor before lifting anything very heavy.

Medical treatments

Your doctor may prescribe medicines to lower your blood pressure or cholesterol, which can help slow the growth of an aneurysm. Lifestyle changes are also very important. You should take any medicines exactly as your doctor prescribes. Surgery, if needed, is done by a vascular specialist.

When is surgery considered?

Surgery is usually considered when an aneurysm is large (around 5.5 cm or bigger in men), growing quickly, or causing symptoms. There are two main procedures: open surgery to replace the weak segment of the aorta, and endovascular repair, a keyhole technique using a stent graft. Your surgical team will discuss which option is safest and most suitable for you.

Living with this condition

If you have a small AAA, you will likely just need an ultrasound every 6 to 12 months to check that it has not grown. Between scans, you can live a normal, active life. Try not to let an AAA rule your thoughts – most people live for many years without any problems from it.

Lifestyle tips

• Stop smoking – your GP can refer you to a stop-smoking service.
• Keep your blood pressure within a healthy range.
• Stay active with moderate exercise like walking, but avoid very heavy lifting or intense straining.
• Eat plenty of fruit, vegetables, whole grains, and lean protein.
• Maintain a healthy weight.

Diet and exercise

A heart-healthy diet and regular, moderate exercise are beneficial for everyone, and especially if you have an AAA. Walking, cycling, and swimming are good choices. Avoid exercises that involve heavy lifting or holding your breath and straining, as these can increase pressure in your abdomen. Ask your doctor for personal advice if you are unsure.

Mental health and emotional wellbeing

Finding out you have an aneurysm can cause worry and anxiety. It is completely normal to feel this way. Talk to your GP or practice nurse about your concerns. Many people find that learning more about the condition and staying with the monitoring plan helps them feel more in control. If anxiety becomes overwhelming, ask about talking therapies through your local health service.

Prevention

You cannot always prevent an AAA, but you can lower your risk by not smoking, keeping your blood pressure healthy, staying physically active, and eating well. Screening is the best way to reduce the risk of dying from an AAA because it finds the problem early, before it becomes dangerous.

Vaccines

There is no vaccine for an AAA. However, staying up to date with recommended vaccinations, such as flu and COVID-19 vaccines, helps protect your overall health and may reduce the chance of serious infections that could affect your heart and blood vessels.

Screening programmes

Screening for AAA is a one-off ultrasound scan. In the UK, the NHS invites men aged 65 to have this screening. If you are over 65 and have not been invited, ask your GP. If you are a woman with risk factors, you can also discuss screening with your GP.

Complications

If left untreated

• The main complication is rupture – when the wall of the aneurysm tears and causes severe internal bleeding. This is a medical emergency and can be quickly life-threatening.
• Another risk is that a blood clot can form inside the aneurysm and break off, possibly blocking a blood vessel elsewhere in the body.
• At the very least, an untreated AAA can continue to grow and become harder to treat successfully.

Long-term outlook

The outlook for someone with an AAA is generally good if it is found early through screening. Most AAAs grow slowly, and many never reach a size that requires surgery. Regular monitoring keeps you safe. For those who need surgery, outcomes are usually good, especially when the aneurysm has not ruptured. Even after a rupture, emergency treatment saves many lives, though the safest way is to find it before that happens.

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