AAA screening

Overview

An abdominal aortic aneurysm (AAA) is a bulge or swelling in the aorta, the main blood vessel that carries blood from your heart to your abdomen, legs, and pelvis. AAA screening is a simple ultrasound scan that checks for this bulge before it causes problems.

AAA is not very common in the general population, but it becomes more common with age, especially in men over 65 and people who smoke or have high blood pressure.

AAA mainly affects older adults, particularly men aged 65 and older. It is less common in women, but women who smoke or have a family history of AAA are also at higher risk.

Symptoms

Common symptoms

• Most AAA have no symptoms at all — they are often found by chance during a scan for another reason or through screening.

Causes

Main causes

• The exact cause is not fully known, but AAA develops when the wall of the aorta weakens and balloons outward.
• Hardening of the arteries (atherosclerosis) is a common underlying cause.
• Injury or infection can sometimes weaken the aortic wall.

Risk factors

• Being male and over 65 years old
• Smoking or a history of smoking
• High blood pressure (hypertension)
• High cholesterol
• Having a close family member (parent, sibling) with AAA

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe pain in your abdomen or back, especially if you feel faint or dizzy — call your local emergency number immediately.

Book a routine appointment if:

• If you are a man over 65 or have risk factors (such as smoking or family history), ask your doctor about AAA screening.
• If you notice a pulsing sensation in your belly or have unexplained back pain, make an appointment to discuss it.

Diagnosis

AAA is usually diagnosed with an abdominal ultrasound scan, which uses sound waves to create images of the aorta inside your belly. This is the same scan used in AAA screening.

Tests that may be done

• Abdominal ultrasound — the main test for detecting AAA
• CT scan (computed tomography) — may be used to get more detail if an aneurysm is found
• Blood pressure check and blood tests to assess overall health

What to expect at your appointment

The ultrasound is simple and painless. You will lie on a table while a gel is applied to your abdomen. A small handheld device (transducer) is moved gently over your skin. The scan takes about 10 to 15 minutes. No special preparation is needed, though you may be asked to avoid eating for a few hours beforehand.

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 need surgery to prevent rupture.

Self-care at home

• If you smoke, quitting is the most important step you can take to slow aneurysm growth.
• Keep your blood pressure and cholesterol under control through diet, exercise, and medication as prescribed by your doctor.
• Attend all follow-up appointments and scans as recommended.

Medical treatments

Your doctor may prescribe medications to lower blood pressure, reduce cholesterol, or manage other conditions that could weaken blood vessels. These treatments help slow the growth of the aneurysm and reduce the risk of rupture.

When is surgery considered?

Surgery is usually considered if the aneurysm is large (typically over 5.5 cm in men, slightly smaller in women) or growing quickly. The two main types are open surgery (repairing the bulge with a graft) and endovascular repair (a less invasive procedure using a stent graft). Your surgical team will discuss which option is best for you.

Living with this condition

Having a small aneurysm that is being monitored usually does not affect daily life. You can continue most normal activities, but it is important to avoid heavy lifting or intense strain that might increase abdominal pressure.

Lifestyle tips

• Quit smoking — it is the single most effective way to reduce the risk of rupture.
• Manage stress through relaxation techniques, gentle exercise, or hobbies.
• Monitor your blood pressure at home if advised by your healthcare provider.

Diet and exercise

A heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins can help control blood pressure and cholesterol. Moderate exercise, such as walking or swimming, is generally safe — but check with your doctor before starting a new activity, especially if your aneurysm is larger.

Mental health and emotional wellbeing

Living with an aneurysm can cause anxiety about rupture. It is normal to feel worried, but remember that small aneurysms often remain stable for years. Talking to your doctor or a counsellor can help you manage these feelings.

Prevention

AAA cannot always be prevented, but you can lower your risk by not smoking, controlling high blood pressure and high cholesterol, and maintaining a healthy weight. Screening is the best way to catch it early when it is most treatable.

Screening programmes

AAA screening is offered to men over 65 in many countries (such as the UK through the NHS AAA Screening Programme). If you are a man over 65 or have risk factors (such as smoking or a family history), ask your doctor if you should be screened. The simple ultrasound scan can detect an aneurysm years before it might cause problems.

Complications

If left untreated

• The aneurysm can grow larger over time, increasing the risk of rupture.
• A ruptured AAA causes severe internal bleeding and is a life-threatening emergency.
• Blood clots can form inside the aneurysm and travel to other parts of the body, causing blockages.

Long-term outlook

With early detection through screening, most AAA can be monitored or treated successfully. The outlook is good: small aneurysms often remain stable for many years, and surgery for larger aneurysms has a high success rate. If an aneurysm ruptures, emergency treatment can still be lifesaving, but the risk of serious complications is much higher. Screening gives you the best chance of avoiding rupture and living a full, healthy life.

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