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Diagram of an abdominal aortic aneurysm.
Diagram of an abdominal aortic aneurysm.

Deadly Belly Bulges: Abdominal Aortic Aneurysms

Screening Can Save Lives and Avoid Emergency Surgery

Could a simple ultrasound screening save your life? If you’re at risk for abdominal aortic aneurysm, it sure can.

The abdominal aorta, a type of blood vessel that is about the size of a garden hose, carries blood away from the heart to the lower parts of the body. The vessel wall can weaken and bulge, and if left untreated, the aneurysm can burst. AAAs usually have no symptoms until they rupture and become a medical emergency. At this point, they can cause sudden death or:

  • Sudden and severe abdominal or back pain
  • Fainting or dizziness
  • Clamminess
  • Nausea or vomiting
  • Rapid heart rate

“Rapid treatment is the difference between life and death with a ruptured aorta,” says Gabriel Abraham Wallace, MD, a board certified vascular surgeon and director of Vascular Surgery at Northwestern Medicine Bluhm Cardiovascular Institute at Palos Hospital. “80% of people with an aortic rupture will die, with 50% not even making it to the hospital. But if the AAA is found with screening it can be fixed preventatively, often with a minimally invasive option and a one-night hospital stay.”

There were 150,000 global deaths attributable to aortic aneurysms in 2020, a 26% increase from 2010, according to 2023 statistics from the American Heart Association.

Research also shows that men* are more likely than women to have an abdominal aortic aneurysm.

Risk factors include:

  • Smoking
  • High blood pressure
  • Family history of aneurysm
  • Age

Screening for Abdominal Aortic Aneurysm

To detect an abdominal aortic aneurysm, your care team may order an abdominal ultrasound. This noninvasive screening uses sound waves to check for swelling in the aorta and does not expose you to radiation. It's the most common test for diagnosing an AAA and takes about 15 minutes to complete. Based on your results, your care team will determine how often you need follow-up care and who you should see.

“We can’t treat what we don’t know,” says George E. Havelka, MD, a vascular surgeon at Northwestern Medicine. “Ultrasound for abdominal aortic aneurysms is an absolute gamechanger for detecting this early so we can intervene before it becomes a true surgical emergency.”

You should get screened with an annual ultrasound for an AAA if you fall into one of these categories:

  • Men ages 50 and older with a first-degree relative with AAA
  • Men ages 65 and older with a smoking history of 100 or more cigarettes in their lifetime
  • Women ages 65 to 75 with a first-degree relative with AAA or a smoking history of 100 or more cigarettes in their lifetime

Talk to your primary care clinician to see if this applies to you.

Treatment for AAAs

When caught early, treatment involves a minimally invasive surgery to reline the aorta and prevent it from rupturing. “If we know about an aneurysm before it ruptures, we can often treat it and have the patient go home the next day,” says Dr. Wallace. “There are usually no symptoms until it may be too late, so that is why screening is so important.”

If an AAA is caught late after it ruptures, treatment involves emergency surgery and a much longer recovery.

Dr. Wallace has developed a streamlined lifesaving protocol just for this type of emergency. All the necessary equipment is already assembled in a kit for minimally invasive treatment of a ruptured AAA, and is ready for quick deployment. When an aortic rupture is diagnosed, Dr. Wallace sends a text to the operating room team, and they open everything in the kit while he and the medical teams stabilize and transfer the patient.

Through two small incisions in the groin, and without opening the stomach, Dr. Wallace and other trained surgeons can stop the bleeding and repair the aorta using a minimally invasive technique called endovascular aortic repair (EVAR). During the procedure, small flexible tubes called catheters are inserted through the arteries in the groin up to the aorta using X-ray guidance. Often the patient does not even require general anesthesia.

After a balloon is inserted to stop the bleeding from the inside, the inside of the aorta is relined with a stent graft, a tube made of thin metal mesh covered with a thin polyester fabric delivered in a catheter. When the stent graft reaches the aorta, it is released from its delivery catheter and fastened into place to reline and repair the aorta’s wall, stop the internal bleeding, and restore normal blood flow.

“With early detection and improved treatment options, the future holds promise for improved outcomes and a better quality of life for those affected with AAA,” says Dr. Wallace.

*Scientists do not always collect information from participants about gender identity. To avoid misrepresenting the results of this research, we use the same terminology as the study authors.

Learn more about aortic aneurysms.

Simple, Effective Abdominal Ultrasound at Northwestern Medicine
Simple, Effective Abdominal Ultrasound at Northwestern Medicine

Northwestern Medicine Bluhm Cardiovascular Institute offers a simple, noninvasive test called an abdominal ultrasound. It can help you know your risk for an abdominal aortic aneurysm and empower you to take steps to prevent a rupture.