Most abdominal aortic aneurysms (AAA) cause no symptoms at all. The aorta, the largest blood vessel in your body, can slowly bulge outward for years without you feeling a thing. That’s what makes AAA dangerous: roughly 80% of cases are discovered incidentally during imaging for something else entirely. Knowing your risk factors and getting screened at the right time is often the only reliable way to find out.
What a Growing Aneurysm Feels Like
When an AAA does produce symptoms, they tend to be vague enough to blame on something else. A deep, constant ache in your belly or along one side of your abdomen is the most common complaint. Some people notice persistent back pain that doesn’t respond to stretching or rest. The most distinctive sign is a throbbing or pulsing sensation near your belly button, caused by blood pushing against the weakened arterial wall with each heartbeat.
These symptoms overlap with kidney stones, muscle strains, stomach ulcers, gallstones, and even urinary tract infections. That overlap is a big reason AAAs get missed. If you have unexplained abdominal or back pain that lingers, especially combined with a pulsing feeling in your midsection, bring it up with your doctor specifically.
Why Most People Have No Warning Signs
The aorta sits deep in the abdomen, behind the intestines and other organs. A bulge can grow to several centimeters before it presses on anything or stretches enough to cause pain. Physical exams aren’t much help either. When doctors press on the abdomen to check for a pulsing mass, they detect an aneurysm only 39% to 68% of the time. Abdominal fat makes detection even harder, lowering that sensitivity further. A normal physical exam does not rule out AAA.
Signs of a Rupture
A ruptured AAA is a life-threatening emergency. The symptoms are sudden and severe: intense pain in the abdomen or back that may radiate into the groin, buttocks, or legs. Unlike the dull ache of a growing aneurysm, rupture pain is sharp, persistent, and impossible to ignore. Other signs include feeling faint or passing out, clammy skin, dizziness, nausea, vomiting, and a racing heartbeat. These indicate internal bleeding and shock. Call emergency services immediately if you or someone near you develops this combination of symptoms.
Who Is Most at Risk
Smoking is the single strongest risk factor, and it’s not close. A large study published in the Journal of the American Heart Association found that current smokers with a long history of heavy use were about 15 times more likely to develop AAA than people who had never smoked. Every five additional pack-years of smoking (one pack a day for five years) increased risk by roughly 50%, up to about 20 pack-years, where the risk plateaued at its highest level.
Other factors that raise your odds:
- Age. AAA is rare before 60 and most common between 65 and 75.
- Sex. Men develop AAA far more often than women, though women who do get one face higher rupture risk.
- Family history. Having a first-degree relative (parent or sibling) with AAA increases your risk significantly.
- High blood pressure and atherosclerosis. Both contribute to weakening of the aortic wall over time, though their independent effect is smaller than smoking.
The Screening That Actually Detects It
Because symptoms are unreliable, a one-time ultrasound is the standard screening tool. The test is painless, takes about 10 to 15 minutes, uses no radiation, and can measure the diameter of your aorta with reasonable accuracy. Ultrasound measurements tend to differ from CT scan measurements by about half a centimeter on average, which is enough to matter for borderline cases but perfectly adequate for initial detection.
CT scans provide more precise measurements and a detailed view of the aneurysm’s shape and location. They’re typically reserved for confirmed cases that need closer monitoring or surgical planning, not for initial screening.
Who Should Get Screened
The U.S. Preventive Services Task Force recommends a one-time screening ultrasound for men aged 65 to 75 who have ever smoked. “Ever smoked” is defined as having smoked 100 or more cigarettes in your lifetime, so even past light smoking qualifies. For men in that age range who have never smoked, screening is offered selectively based on other risk factors like family history or cardiovascular disease.
For women, the picture is less clear. The Task Force recommends against routine screening for women who have never smoked and have no family history. For women aged 65 to 75 who have smoked or have a family history, the evidence is considered insufficient to make a firm recommendation either way. If you’re a woman with those risk factors, it’s worth discussing screening directly with your doctor.
What Happens After Detection
Finding an aneurysm doesn’t automatically mean surgery. The approach depends almost entirely on size. A normal aorta is about 2 centimeters in diameter. An aneurysm is generally defined as a widening to 3 centimeters or more.
Small aneurysms (under about 5 centimeters) are monitored with periodic ultrasounds, typically every 6 to 12 months. The goal is to track growth rate. Most small aneurysms grow slowly, around 1 to 3 millimeters per year, and many never reach a size that requires intervention.
The widely accepted threshold for surgical repair is 5.5 centimeters for men and 5.0 centimeters for women. Both the Society for Vascular Surgery and its European counterpart endorse these numbers. Recent research has suggested that in some patients, particularly younger ones in good health, slightly larger thresholds may be appropriate. One analysis found optimal repair thresholds of 6.9 centimeters for an average-health 60-year-old man and 6.1 centimeters for an average-health 60-year-old woman. But these findings haven’t changed standard guidelines yet, and decisions are made case by case based on growth rate, overall health, and aneurysm shape.
Repair is done either through open surgery or with a less invasive procedure where a reinforcing stent is threaded through a blood vessel in the groin and placed inside the aneurysm. The stent-based approach has a shorter hospital stay and faster initial recovery, typically a few days rather than a week or more.
What You Can Do Now
If you’re a man between 65 and 75 who has smoked at any point in your life, getting a screening ultrasound is the single most effective step. If you’re younger but have a strong family history or multiple cardiovascular risk factors, ask your doctor whether early screening makes sense for you.
Quitting smoking slows the growth of existing aneurysms and reduces the risk of developing one. Managing blood pressure helps protect the aortic wall. Neither step can reverse an aneurysm that already exists, but both meaningfully reduce the chance of rupture. If you’ve been told you have a small aneurysm, keeping your follow-up ultrasound appointments is critical. Growth can accelerate unpredictably, and catching that change early is the difference between a planned repair and an emergency.