An abdominal aortic aneurysm (AAA) can enlarge quietly for years without causing pain or obvious warning signs. That is why it is often called a “silent killer.” Most AAAs are asymptomatic until they rupture, which can cause sudden, life-threatening internal bleeding. The encouraging news is that people at highest risk can often be screened before symptoms appear with a simple abdominal ultrasound.
Whether you are researching for yourself or an aging parent, three questions matter most: Who is at risk? What symptoms require urgent action? And should screening be the next step?
Key Takeaways
- Most abdominal aortic aneurysms cause no early symptoms. Feeling well does not rule one out.
- Possible warning signs include deep abdominal, side, or back pain and a pulsing sensation near the navel.
- Sudden, severe abdominal or back pain, fainting, or a rapid heartbeat may signal rupture. Call 911.
- Major risk factors include age 65 or older, male sex, current or past smoking, high blood pressure, and a first-degree family history of AAA.
- The standard screening test is a painless, noninvasive abdominal ultrasound.
- The USPSTF recommends one-time ultrasound screening for men ages 65 to 75 who have ever smoked.
What Is an Abdominal Aortic Aneurysm?
The aorta is the body’s largest artery. It carries oxygen-rich blood away from the heart and travels through the chest and abdomen before branching toward the legs.
An AAA develops when a weakened section of the aorta in the abdomen stretches outward. Think of a thin, ballooning spot on a tire’s sidewall: pressure continues to push against the weak area, and the bulge may expand. An AAA is typically defined as an abdominal aorta measuring 3 centimeters or more in diameter.
As an aneurysm becomes larger or grows quickly, the weakened wall may rupture. Early detection allows a vascular specialist to monitor it and recommend treatment before the risk becomes urgent.
Why AAA Symptoms Can Be Easy to Miss
Early AAAs Are Usually Silent
Many people with an AAA feel completely normal. There may be no pain and no outward sign that the aorta is enlarging. This is why screening is based on risk factors rather than symptoms alone.
A lack of symptoms does not mean a lack of risk, especially in an older adult with a smoking history or a close relative who had an AAA.
Symptoms of an Enlarging or Symptomatic AAA
When an AAA does cause symptoms, they may include:
- Deep, persistent pain in the abdomen or side
- Back pain that is new or unexplained
- A pulsing, throbbing, or heartbeat-like feeling in the abdomen, often near the navel
- Pain extending into the groin, buttocks, or legs
These symptoms can have other causes, but they deserve prompt medical evaluation—particularly in someone with several AAA risk factors.
Symptoms of a Ruptured AAA: Call 911
A ruptured AAA is a medical emergency. Warning signs may include:
- Sudden, severe abdominal or back pain
- Light-headedness, fainting, or collapse
- A rapid heartbeat
- Sudden weakness or signs of shock
Do not wait for the pain to improve or drive yourself to the hospital. Call 911 immediately. Rapid treatment can be lifesaving.
Who Is Most at Risk for an Abdominal Aortic Aneurysm?
Risk rises when several factors are present together.
Major AAA Risk Factors
- Age 65 or older: AAAs become more common with age.
- Male sex: Men develop AAAs more often than women.
- Current or former smoking: Smoking is the most important modifiable risk factor, and risk can remain elevated after quitting.
- Family history: Risk is higher when a parent, sibling, or child has had an AAA.
- High blood pressure: Ongoing pressure stresses artery walls.
- Atherosclerosis or high cholesterol: Plaque buildup and vascular disease often occur alongside AAA.
- Other vascular disease: Coronary artery disease, peripheral artery disease, or another aneurysm may increase concern.
For screening purposes, an “ever smoker” commonly means someone who has smoked at least 100 cigarettes during their lifetime. Many former smokers therefore qualify for the same risk-based discussion as current smokers.
Can Women Develop an AAA?
Yes. Women are less likely than men to develop an AAA, but smoking and family history still matter.
The USPSTF says evidence is insufficient to recommend for or against routine screening in women ages 65 to 75 who have ever smoked or have a family history of AAA. The decision should therefore be individualized in consultation with a healthcare professional.
Early Detection: How AAA Screening Works
What Happens During an Abdominal Ultrasound?
An abdominal aortic ultrasound uses sound waves to create images and measure the aorta. You generally lie on your back while a technologist applies gel and moves a handheld probe over the abdomen.
The test is typically painless and noninvasive, and it uses no ionizing radiation. If an aneurysm is found, ultrasound can monitor its size over time. CT or MRI may be ordered when more detail about its shape or location is needed.
Who Should Receive Routine AAA Screening?
Current U.S. Preventive Services Task Force guidance for adults without AAA symptoms recommends:
- Men ages 65 to 75 who have ever smoked: One-time ultrasound screening is recommended.
- Men ages 65 to 75 who have never smoked: Screening may be offered selectively after considering family history and other vascular risks.
- Women ages 65 to 75 who have ever smoked or have a family history of AAA: Evidence is insufficient for a universal recommendation; decisions should be individualized.
- Women who have never smoked and have no family history of AAA: Routine screening is not recommended.
Guidelines are a starting point. A vascular specialist may recommend evaluation outside these groups when symptoms, a strong family history, another aneurysm, or significant vascular disease raises concern.
What Happens If an AAA Is Found?
An AAA diagnosis does not automatically mean surgery. Management depends on its size, growth rate, symptoms, anatomy, and the patient’s overall health.
A smaller aneurysm may be followed with scheduled ultrasounds while the care team addresses smoking, blood pressure, cholesterol, and overall cardiovascular health. A larger, rapidly growing, or symptomatic aneurysm may require evaluation for minimally invasive endovascular repair or open surgery.
Reliable follow-up is essential. Keeping every recommended imaging and specialist appointment helps the care team identify important changes before they become an emergency.
Common Questions About AAA Screening
How Much Does an Abdominal Aortic Aneurysm Screening Cost?
Cost varies by insurance, facility, and whether the test is preventive screening or diagnostic imaging for symptoms.
Medicare Part B covers one lifetime AAA screening ultrasound for eligible at-risk people with a provider referral. Patients pay nothing when the provider accepts Medicare assignment. Eligibility includes a family history of AAA or being a man ages 65 to 75 who has smoked at least 100 cigarettes during his lifetime.
Private insurance benefits and referral rules vary, so confirm coverage before the appointment.
Can I Lower My Risk of an AAA?
You cannot change your age, sex, or family history, but you can address important vascular risks:
- Stop smoking
- Keep your blood pressure under control
- Manage cholesterol
- Stay active as medically appropriate
- Take prescribed medications as directed
- Attend all recommended vascular follow-up appointments
These steps do not replace screening or surveillance, but they support artery health and may help slow the progression of vascular disease.
What to Do Next
If you are 65 or older, currently smoke or smoked in the past, or have a first-degree relative with an AAA, do not wait for symptoms. Ask your primary care clinician or a vascular specialist whether an abdominal ultrasound is appropriate.
Maryland Vascular Specialists offers abdominal aortic aneurysm ultrasound evaluation through its vascular labs. A vascular specialist can review your risk, explain screening results, and create a surveillance or treatment plan when needed.
Early detection can turn a hidden threat into a condition that can be measured, monitored, and treated.
Medical Disclaimer
This content is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Speak with a qualified healthcare professional about personal symptoms and screening needs. If you have sudden, severe abdominal or back pain, fainting, or other possible signs of a ruptured AAA, call 911 immediately.