Abdominal aortic aneurysms (AAAs) are a serious but often silent condition. An AAA occurs when the wall of the aorta—the body’s main blood vessel—becomes weakened and bulges outward like a balloon. If it grows too large, it can rupture, leading to life-threatening bleeding.

“Ruptured aneurysms are the 15th leading cause of death in the United States and the 10th leading cause for men over age 55,” explains Mathew Wooster, MD, a vascular surgeon Lexington Health Heart and Vascular Center. “That’s why awareness and screening are so important.”

How Common Are AAAs?
AAAs are present in about 1.4% of adults over age 50. Each year, ruptured aneurysms account for approximately 15,000 deaths nationwide.

Who Is at Risk?
The chances of developing an aneurysm increase with age, and men are at greater risk than women. Other risk factors include:

• Hypertension (high blood pressure)
• High cholesterol
• Smoking – the most significant modifiable risk factor
• Family history of aneurysm
• Genetic connective tissue disorders, such as Ehlers-Danlos or Marfan syndrome

While women are less likely to develop AAAs, Dr. Wooster cautions that they are also less likely to be screened. “Because women are not screened as often, they may present later and in more urgent situations. It is especially critical for women with genetic conditions like Ehlers-Danlos or Marfan syndrome to be evaluated.”

Should You Be Screened?
Current guidelines recommend:

• All men over age 65 who have ever smoked
• Anyone with a family history of AAA (screening should happen earlier, ideally before the age at which the family member was diagnosed)
• Individuals with multiple risk factors
• Patients with known coronary artery disease or peripheral artery disease

“I often advise patients with a family history of AAA to get a one-time ultrasound,” says Dr. Wooster. “It’s a simple test that can save lives.”

What Does Screening Involve?
The most common screening method is a painless abdominal ultrasound, which can evaluate the aorta and iliac arteries.

• For patients with genetic predispositions such as Marfan, Loey-Dietz, or Ehlers-Danlos syndrome, a whole-body MRI may be recommended at a younger age.
• For individuals who are significantly overweight, a non-contrast CT scan can be performed if the ultrasound does not provide clear images.

What If an Aneurysm Is Found?
The next steps depend on the size of the aneurysm:

• Less than 3 cm: Repeat ultrasound in 5 years
• 3–3.9 cm: Repeat in 3 years
• 4–4.9 cm: Repeat in 1 year
• 5.0 cm or larger: Surgical repair may be considered, or closer monitoring with scans every 6 months

Regardless of size, all patients are advised to begin “best medical therapy,” which involves controlling blood pressure, lowering cholesterol, and stopping smoking.

Treatment Options
If the aneurysm is large enough or causing symptoms, surgery is recommended.

• Open surgical repair: An incision is made in the abdomen to remove the aneurysm and replace it with a graft.
• Endovascular repair: A less invasive option, this involves threading a catheter through the groin and placing a stent inside the artery to reinforce it.

“Fortunately, both approaches are highly effective,” notes Dr. Wooster. “Nearly 90% of AAA repairs today are done endovascularly, but we always tailor the approach to each patient’s needs.”

The Bottom Line
Abdominal aortic aneurysms can be life-threatening, but with proper screening and timely treatment, they are highly manageable. “The most important step is early detection,” emphasizes Dr. Wooster. “A simple ultrasound can make the difference between life and death.”