Abdominal Aortic Aneurysm – Causes, Symppms,Treatment

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 10 min read
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Abdominal Aortic Aneurysm (AAA) is a life-threatening condition that requires monitoring or treatment depending upon the size of the aneurysm and/or symptomatology. AAA may be detected incidentally or at the time of rupture. An arterial aneurysm is defined as a permanent localized dilatation of the...

For severe symptoms, danger signs, pregnancy, child illness, or sudden worsening, seek urgent medical care.

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Article Summary

Abdominal Aortic Aneurysm (AAA) is a life-threatening condition that requires monitoring or treatment depending upon the size of the aneurysm and/or symptomatology. AAA may be detected incidentally or at the time of rupture. An arterial aneurysm is defined as a permanent localized dilatation of the vessel at least 150% compared to a relative normal adjacent diameter of that artery [rx]. Classification of Abdominal Aortic Aneurysm...

Key Takeaways

  • This article explains Classification of Abdominal Aortic Aneurysm in simple medical language.
  • This article explains Causes of Abdominal Aortic Aneurysm in simple medical language.
  • This article explains Symptoms of Abdominal Aortic Aneurysm in simple medical language.
  • This article explains Diagnosis of Abdominal Aortic Aneurysm in simple medical language.
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Emergency safety firstUrgent warning signs are highlighted below.

Seek urgent medical care if you notice

These warning signs are general safety guidance. Local emergency numbers and clinical judgment should always come first.

  • Severe symptoms, breathing difficulty, fainting, confusion, or rapidly worsening illness.
  • New weakness, severe pain, high fever, or symptoms after a serious injury.
  • Any symptom that feels urgent, unusual, or unsafe for the patient.
1

Emergency now

Use emergency care for severe, sudden, rapidly worsening, or life-threatening symptoms.

2

See a doctor

Book a professional medical evaluation if symptoms persist, worsen, recur often, affect daily activities, or occur in a high-risk patient.

3

Learn safely

Use this article to understand possible causes, tests, treatment options, prevention, and questions to ask your clinician.

Abdominal Aortic Aneurysm (AAA) is a life-threatening condition that requires monitoring or treatment depending upon the size of the aneurysm and/or symptomatology. AAA may be detected incidentally or at the time of rupture. An arterial aneurysm is defined as a permanent localized dilatation of the vessel at least 150% compared to a relative normal adjacent diameter of that artery .

Classification of Abdominal Aortic Aneurysm

Aorta segments, with thoracic aorta in area marked in green. Aortic aneurysms are classified by their location on the aorta.
  • An aortic root aneurysm, or aneurysm of the sinus of Valsalva.
  • Thoracic aortic aneurysms are found within the chest; these are further classified as ascending, aortic arch, or descending aneurysms.
  • Abdominal aortic aneurysms, “AAA” or “Triple-A”, the most common form of aortic aneurysm, involve that segment of the aorta within the abdominal cavity. Thoracoabdominal aortic aneurysms involve both the thoracic and abdominal aorta.
  • Thoracoabdominal aortic aneurysms comprise some or all of the aorta in both the chest and abdomen and have components of both thoracic and abdominal aortic aneurysms.

Causes of Abdominal Aortic Aneurysm

An abdominal aortic aneurysm may arise if the vessel wall becomes less elastic, for example as a normal part of aging. Other possible causes include smoking and too much pressure on the blood vessel, for instance, due to high blood pressure. If one part of the vessel wall starts bulging, it tends to continue to expand, and the aneurysm grows larger.

  • Tobacco smoking – More than 90% of people who develop an AAA have smoked at some point in their lives.[21]
  • Alcohol and hypertension – The infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation caused by prolonged use of alcohol and hypertensive effects from abdominal edema which leads to hemorrhoids, esophageal varices, and other conditions, is also considered a long-term cause of AAA.
  • Genetic conditions – including Marfan syndrome (In an IRAD review, Marfan syndrome was present in 50% of those under age 40, compared with only 2% of older patients), Ehlers-Danlos syndrome, Turner syndrome, and bicuspid aortic valve. In patients with Marfan syndrome, cystic medial necrosis is seen in the tissues
  • Atherosclerosis – The AAA was long considered to be caused by atherosclerosis because the walls of the AAA frequently carry an atherosclerotic burden. However, this hypothesis cannot be used to explain the initial defect and the development of occlusion, which is observed in the process.[rx]
  • Other causes of the development of AAA include – infection, trauma, pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।" data-rx-term="arthritis" data-rx-definition="Arthritis means joint inflammation causing pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।">arthritis, and cystic medial necrosis.[rx]
  • Hypertension (occurs in 70% of patients with distal Standford type B AAD).
  • An abrupt, transient, severe increase in blood pressure (e.g., strenuous weight lifting and use of sympathomimetic agents such as cocaine, ecstasy, or energy drinks).
  • Pre-existing aortic aneurysm.
  • Pregnancy and delivery (risk compounded in pregnant women with connective tissue disorders such as Marfan syndrome).
  • Family history.
  • Aortic instrumentation or surgery (coronary artery bypass, aortic or mitral valve replacement and percutaneous stenting or catheter insertion).
  • Inflammatory or infectious diseases that cause vasculitis (syphilis, cocaine use)
  • Risk factors for AAA include advanced age, tobacco use, hypertension, hypercholesterolemia, Chronic obstructive pulmonary disease, and male gender. Atherosclerosis is the most commonly associated pathology, but other causes such as cystic medial necrosis, dissection, syphilis, HIV and Ehlers-Danlos syndrome have been identified.

There are a number of factors that can increase someone’s risk of developing an abdominal aortic aneurysm.

  • Sex: Abdominal aortic aneurysms are more common in men than in women.
  • Age: The risk increases with age. Most people who have an abdominal aortic aneurysm are over 65 years old.
  • Smoking: Smoking is the most important risk factor that you can influence yourself.
  • Blood pressure: High blood pressure makes an abdominal aortic aneurysm more probable.
  • Blood lipids: High levels of blood lipids (blood fats) increase the likelihood of an aneurysm developing.
  • Genes: People who have white skin or close relatives who have had an abdominal aortic aneurysm are at greater risk.

Symptoms of Abdominal Aortic Aneurysm

Most abdominal aortic aneurysms don’t cause any symptoms and go unnoticed.

  • Larger aneurysms may cause backache or abdominal pain, or pain in your sides. Then it may be discovered if a doctor looks for the source of the pain.
  • If the abdominal aorta ruptures, it causes sudden pain: Back pain means pain in the spine, muscles, discs, joints, or nerves of the back. সহজ বাংলা: পিঠ/কোমরের ব্যথা।" data-rx-term="back pain" data-rx-definition="Back pain means pain in the spine, muscles, discs, joints, or nerves of the back. সহজ বাংলা: পিঠ/কোমরের ব্যথা।">back pain that radiates to the sides or groin. A large amount of blood is lost through the rupture, causing dizziness, loss of consciousness, and eventually circulatory collapse.

Diagnosis of Abdominal Aortic Aneurysm

A physical examination can prove useful diagnostically, but should not delay the above emergency investigations. It should include:

  • measurement of the BP in both arms (unequal BP is a sign, though not a reliable sign)
  • documentation of all peripheral pulses (lack of peripheral pulses may be the only sign if the dissection spares the ascending aorta)
  • close attention to heart sounds (aortic regurgitation and tamponade are possible with proximal extension)
  • neurologic examination (hemiplegia or paraplegia can result from occlusion of the carotid arteries and anterior spinal arteries, respectively)
  • assessment of renal function, including urine microscopy and catheterization for accurate measurement of renal output
  • a chest x-ray, which often shows a distended aorta or generalized widening of the mediastinum

Treatment of Abdominal Aortic Aneurysm

All patients with small abdominal aortic aneurysms who do not undergo repair need periodic follow up with an ultrasound every 6 to 12 months to ensure that the aneurysm is not expanding.

One RCT examined the effect of roxithromycin on aneurysm growth. patients with small aneurysms were given either roxithromycin or placebo for four weeks and subsequently followed up for a mean of 1.5 years. Once adjustments had been made for smoking, blood pressure, and IgA, there was a significant difference in aneurysm growth between treatment and placebo groups.

Matrix metalloproteinase (MMP) inhibition

Tetracyclines have long been known to prevent connective tissue breakdown by their inhibitory effect on MMPs and several experimental studies have suggested that doxycycline reduced the growth of degenerative aneurysms and suppressed MMP-9 production in the rat elastase model. In a clinical trial, preoperative treatment with doxycycline caused a reduction in both the expression of macrophage MMP-9 mRNA and the activity of MMP-2 in aneurysm tissue.

Drugs Acting on the Renin/Angiotensin Axis

In 1998 a French group reported the effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II antagonists in a tendon. সহজ বাংলা: মাংসপেশি/টেনডনে টান।" data-rx-term="strain" data-rx-definition="A strain is injury to a muscle or tendon. সহজ বাংলা: মাংসপেশি/টেনডনে টান।">strain of rat prone to rupture of the internal elastic lamina of the aorta. To ensure any beneficial effects were not due to the antihypertensive properties of the drugs, they were compared to hydralazine and two calcium channel antagonists. Both ACE inhibitor and angiotensin II antagonists prevented a rupture of the internal elastic lamina, suggesting this was due to the effect on angiotensin II and not on another part of the renin/angiotensin system

Anti-chlamydial therapy

SVS Guidelines on Management of Patients With Abdominal Aortic Aneurysms

The Society for Vascular Surgery (SVS) issued updated guidelines on the care of patients with abdominal aortic aneurysms that include the following:

  • Yearly surveillance imaging in patients with an AAA of 4.0 to 4.9 cm in diameter.
  • Assessment of distal leg pulses at each clinic visit.
  • For unruptured AAA, endovascular aneurysm repair (EVAR) is recommended.
  • Endovascular procedure should only be done in a hospital that has performed at least 10 cases every year and has a conversion rate to open of less than 2%
  • Elective AAA open surgery should be done in hospitals with a mortality of less than 5% and that performs at least 10 open cases a year
  • For ruptured AAA, a facility with door to intervention time of less than 90 minutes is preferred.
  • Recommend treatment of type I and III endoleaks as well as of type II endoleaks with aneurysm expansion.
  • bacterial infections. সহজ বাংলা: ব্যাকটেরিয়ার সংক্রমণের ওষুধ।" data-rx-term="antibiotic" data-rx-definition="An antibiotic is a medicine used to treat bacterial infections. সহজ বাংলা: ব্যাকটেরিয়ার সংক্রমণের ওষুধ।">Antibiotic prophylaxis is not recommended before respiratory tract procedures, genitourinary, dermatologic, gastrointestinal or orthopedic procedures unless there is a potential for infection as in an immunocompromised patient.
  • Color duplex ultrasonography should be used for postoperative surveillance after Endovascular surgery.
  • A preoperative 12-lead electrocardiogram is recommended in all patients undergoing EVAR or open surgical repair within 4 weeks of the elective surgery.
  • If the patient just had a drug-eluting stent placed, then open aneurysm surgery should be delayed for at least 6 months; or one can perform endovascular surgery while the patient is on dual antiplatelet therapy.
  • Only transfuse blood perioperatively if hemoglobin is less than 7 g/dL.
  • Elective repair should be recommended in patients at low risk when the AAA is 5.5 cm.
  • The open surgery should be done under general anesthesia.

If the risk of rupture is high, surgery is the only preventive measure. There are two types of surgery for a large aneurysm:

  • Open surgery through an abdominal incision (cut): The aneurysm is opened, and replaced by an artificial vessel (graft).
  • The endovascular procedure through a small incision in the groin: A small tube (stent) is put into the artery, pushed along to where the aneurysm is, and implanted in the aneurysm.

Both of these procedures are associated with risks. Determining whether a surgical procedure is a good idea is a very personal decision: On the one hand there are risks, but on the other there is the possible danger of the aneurysm rupturing.

Complications

  • Bleeding
  • Limb ischemia
  • Delayed rupture secondary to endoleak
  • Abdominal compartment syndrome
  • Myocardial infarction
  • Pneumonia
  • Graft infection
  • Colon ischemia
  • Renal failure
  • Bowel obstruction
  • Blue toe syndrome
  • Amputation
  • Impotence
  • Lymphocele
  • Death

Postoperative and Rehabilitation Care

After repair, it is essential that the patient discontinue smoking, eat a healthy diet, and maintain a healthy weight. Physical and/or occupational therapy may be necessary.

Other Issues

  • Patients with abdominal aortic aneurysms should quit smoking is to reduce the risk of enlargement.
  • Medical optimization of hypertension, hyperlipidemia, diabetes, and other atherosclerotic risk factors.
  • Moderate exercise does not cause rupture or AAA expansion .
  • The Society for Vascular Surgery Guidelines recommends ultrasound screening for all men and woman 65 years of age or older who have smoked or have a family history of AAA(20).
  • Surveillance Guidelines for AAA per the Society for Vascular Surgery using duplex US are the following:

    • 3-year intervals for patients with an AAA between 3.0 and 3.9 cm
    • 12-month intervals for patients with an AAA of 4.0 to 4.9 cm in diameter.
    • 6-month intervals for patients with an AAA between 5.0 and 5.4 cm in diameter
  • Those patients with an initial aortic diameter <3 cm have a low risk for rupture. At this time there are no recommendations for surveillance; however, it should be noted that gradual expansion in these patients has been noted over time.
  • Patients presenting with asymptomatic AAA should be considered for urgent repair.
  • Asymptomatic patients with AAA demonstrating an aortic diameter > 5.4 cm or those with the rapid expansion of small AAA should be evaluated for repair.
  • The goal of AAA repair is to increase survival. Consideration of quality of life after the repair is important; particularly in those with shortened life expectancy due to medical co-morbidities or cancer.
  • Endovascular repair may offer fewer complications and better quality of life in those at high risk for open repair up to 1-year post-intervention .

Factors that increase the operative risk for abdominal aortic aneurysm repair include:

  • Severe heart disease.
  • Severe chronic obstructive pulmonary disease.
  • Poor renal function
  • Comorbidities such as stroke, diabetes, hypertension, and advanced age can increase open surgical risk. These individuals should be considered for endovascular stenting of the aneurysm if the aortic anatomy permits.

References

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Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

General physician, gastroenterologist, surgeon, or emergency service if severe.

What to tell the doctor

  • Write pain location, vomiting, fever, stool/urine changes, pregnancy possibility, and food history.

Questions to ask

  • Could this be appendicitis, gallbladder, ulcer, kidney stone, infection, or gynecological emergency?
  • Do I need ultrasound or urgent surgical review?

Tests to discuss

  • Abdominal examination
  • CBC, urine test, pregnancy test when relevant
  • Ultrasound abdomen when indicated

Avoid these mistakes

  • Do not delay care for severe pain, rigid abdomen, persistent vomiting, black stool, pregnancy pain, or fainting.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Avoid heavy lifting, sudden bending, and prolonged bed rest.
  • Use comfortable posture and gentle movement as tolerated.
  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Orthopedic / spine specialist, physical medicine doctor, or qualified clinician
Tests to discuss with doctor
  • Neurological examination for leg power, sensation, reflexes, and straight leg raise
  • X-ray only if injury, deformity, long-lasting pain, or doctor suspects bone problem
  • MRI discussion if severe nerve symptoms, weakness, bladder/bowel problem, or persistent symptoms
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
  • Is physiotherapy, posture correction, or activity modification needed?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Abdominal Aortic Aneurysm – Causes, Symppms,Treatment

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

RX Patient Help

Ask a health question safely

Write your symptom story. A health professional or site editor can review it before any answer is prepared. This box is not for emergency care.

Emergency first: Severe chest pain, breathing trouble, unconsciousness, stroke signs, severe injury, heavy bleeding, or rapidly worsening symptoms need urgent local medical care now.

Frequently Asked Questions

Is this article a replacement for a doctor?

No. It is educational content only. Patients should consult a qualified clinician for diagnosis and treatment.

When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.

References

Add references, clinical guidelines, textbooks, journal articles, or trusted medical sources here. You can edit this area from the RX Article Professional Blocks panel.

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