What Is an Abdominal Aortic Aneurysm?

Written by Tammy Worth
Medically Reviewed by Jabeen Begum, MD on May 13, 2025
8 min read

An abdominal aortic aneurysm is a condition where the lower section of your aorta —  in your abdomen — weakens and bulges outward. Your aorta is the major blood vessel supplying blood from your heart to the rest of your body. It runs all the way down into your abdomen, the part of your body between your chest and pelvis.

The walls of your aorta are strong and flexible, so they can manage the flow of blood being pumped from your heart. Certain things, such as smoking, some medical conditions, and older age, can weaken the walls of the aorta. When that happens, it becomes harder for it to manage the constant pressure of blood flow. Aneurysms can happen anywhere on your aorta, but about 75% happen in the abdominal area.

An abdominal aortic aneurysm is a serious condition because if the enlarged part of the aorta were to burst, the bleeding could be life-threatening.

Most of the time, you won’t have symptoms if you have an abdominal aortic aneurysm. Some aneurysms start out small and get bigger over time. Others grow quickly, and some never grow at all. You will probably only have symptoms if the aneurysm is near the point of bursting.

Frank Caputo, MD, the vascular surgery director of the Aortic Center at the Cleveland Clinic, says this condition is often called “the silent killer.” In fact, an employee at his clinic had an abdominal aortic aneurysm measuring about 7 centimeters (doctors recommend surgery to fix them at 5.5 centimeters), and he didn’t know it.

“He schedules surgery for this condition all day long, and he only found his when he was screening for something else,” Caputo says. “He’s only about 150 pounds, and he had an aneurysm the size of a basketball in his belly. That’s how asymptomatic these things are.”

If yours is growing and may be close to rupturing, you may feel:

  • Pain deep inside, or on the side of, your abdomen, lower back, groin, or down your legs
  • An aching or pulsating feeling (like a heartbeat) in any of these areas that lasts a few hours or days
  • Coldness in one of your feet or a blue or black toe, which may indicate a blood clot blocking blood flow to one of your legs or feet

If you have any of these signs, see your doctor immediately or call 911.

If your aneurysm has ruptured, you need to get immediate medical attention. You may have sudden symptoms that include:

  • Serious pain in your abdomen, legs, or lower back
  • Dizziness or fainting
  • Nausea
  • Clammy skin
  • Fast heartbeat
  • Shortness of breath
  • A fast, extreme drop in blood pressure

Doctors don’t know exactly why abdominal aortic aneurysms happen, but they do know several things that can play a part in causing weakness in the walls of your aorta:

Abdominal aortic aneurysms happen in about 1.1 million U.S. adults aged 50-84 each year. Men and people assigned male at birth (AMAB) are four times more likely to have one than women or people assigned female at birth (AFAB). 

If you have certain conditions or risk factors, you are more likely than others to get abdominal aortic aneurysms. These include:

  • Being a man or person AMAB
  • Being 50 or older for men or people AMAB and older than 65 for women or people AFAB
  • Being White
  • Having a family history of the condition, especially in a first-degree relative, such as a parent or sibling
  • Having a history of tobacco use (which is defined as smoking at least 100 cigarettes in your lifetime)
  • Having a vascular connective tissue disease that is genetic, such as lupus, rheumatoid arthritis, Marfan syndrome, or Turner’s syndrome

Also, your chance of having this condition is higher if you have had an aneurysm before.

If your odds of getting an aneurysm are high, you might want to talk with your doctor about a screening.

Cholesterol and abdominal aortic aneurysm

Having high total cholesterol and LDL cholesterol (or “bad” cholesterol) is a risk factor for having an abdominal aortic aneurysm. This may be because of increased inflammation in the body from high cholesterol and the effect of plaque on the arteries.

“The wall of the aorta is a living organism, so if it accumulates plaque, it makes it less able to respond to stress as it expands, so it weakens,” says Ali Azizzadeh, MD, Director of the Division of Vascular Surgery and Vice Chair of the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai. 

Studies show that having low levels of HDL cholesterol, or “good” cholesterol, can also increase your risk. This cholesterol helps protect your arteries by clearing out the bad cholesterol from your blood.

Because abdominal aortic aneurysms often show no symptoms, your doctor might be the first to find them, perhaps after a routine exam. If he thinks you have one, he may order specific tests.

Abdominal ultrasound. This is the most common test to look for abdominal aortic aneurysms. A technician will apply warm gel to your abdomen and use a special device that uses sound waves to look inside your body. It’s a painless procedure and helps spot the signs of an aneurysm.

MRI. This test, which is also painless, creates images of the inside of your abdomen using radio waves and a magnetic field. Your doctor will inject you with a special dye that will show up on the images and reveal where the aneurysm is located and how big it is. You have to lie down on a table that slides into a tunnel. Some people find MRI machines loud and confining. Tell your doctor if you have problems with small spaces.

CT scan. You lie on a table for this as well. Like the MRI, this machine is loud, but it’s not as closed-in. It creates clear X-ray images of your aorta.

Screening recommendations

Your doctor may suggest screening with an ultrasound if you are:

  • A man or person AMAB over the age of 65 and have ever smoked cigarettes
  • A nonsmoking man or person AMAB who has risk factors, such as a family history

There aren’t specific guidelines for screening women because they have a lower risk of having the condition. But Azizzadeh says women over the age of 65 who have ever smoked or have a family history of the condition should talk to their doctor about screening.

Your doctor may also recommend genetic screening, particularly if you have an aneurysm at an early age. Some inherited conditions affect other vessels in the body and are common in people with abdominal aortic aneurysms. A cheek swab will be used to test for more than 20 other possible conditions.

The goal of treatment is to keep the aneurysm from bursting. Like a balloon weakens as it inflates, the walls of the aorta get weaker as the aneurysm grows.  

If you’re not having any symptoms, and your aneurysm is small, your doctor may choose to simply monitor it over time. They will also try to keep it from growing by helping control your blood pressure and cholesterol levels, and by helping you quit smoking if you smoke. 

You’ll likely need regular tests to check on its size and growth. They may have you come in for screening every 6-12 months, depending on the size and growth of the aneurysm. Caputo says if your aneurysm is 3 centimeters and the growth is less than 0.5 centimeters every six months, your doctor will continue to monitor it. If it grows more quickly than that, it’s considered aggressive.

If it’s growing fast or causing you problems, your doctor may decide to operate. Caputo says if you are a man or person AMAB with an aneurysm that is 5.5 cm or a woman or person AFAB with a 5-centimeter large aneurysm, surgery is recommended. There are also other times, such as if you have formed a blood clot, when your doctor might suggest surgery on smaller tumors.

Endovascular surgery is the operation used most often on abdominal aortic aneurysms. This involves your doctor attaching an artificial graft to a thin tube called a catheter. They’ll feed it through an artery in your leg all the way to your aorta. The graft strengthens the weakened area of the aorta. This procedure is less invasive, meaning the doctor only has to make small cuts (incisions), and your healing time will be shorter.

Open surgery is another option for an abdominal aortic aneurysm. Your doctor will take out the damaged part of your aorta and replace it with a graft. Recovery from this procedure can take up to a month.

You and your doctor can discuss which option is best for you.

There are no medications to prevent an abdominal aortic aneurysm. But there are things you can do to help lower your odds:

  • If you smoke, quit.
  • Eat more “heart-healthy”­ foods — fruits, vegetables, and whole grains, for example.
  • Exercise regularly to make your blood vessels stronger.
  • Don’t exercise too hard. Also, avoid stressful situations that may increase your blood pressure.

Also, you and your doctor should watch your blood pressure and cholesterol to make sure they’re normal.

Abdominal aortic aneurysms are often found when you are screening for other conditions, as they usually don’t cause symptoms until they are about to rupture. When they rupture, it is a medical emergency. If you have risk factors like a family history of the condition or a history of smoking, it’s important to talk to your doctor about screening.

Does smoking increase my risk for abdominal aortic aneurysm​? 

Yes, smoking at least 100 cigarettes over your lifetime is a major risk factor for having an abdominal aortic aneurysm.

How long does abdominal aortic aneurysm surgery take? 

Depending on the type of surgery you have — whether it’s open, through the abdomen, or closed, through an artery in the groin — it could take anywhere from three to five hours. 

What type of doctor treats abdominal aortic aneurysms? 

A vascular surgeon, who specializes in treating arteries and veins, can diagnose and treat the condition.