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Aortic Aneurysm Warning Signs: What to Watch For & When to Act
An aortic aneurysm can grow for years without a single symptom. That silence is exactly what makes it dangerous. The aorta is the body’s largest
Medically Reviewed by
Dr. Paul Hanna, DO, RPVI
Board Certified Vascular Surgeon
An aortic aneurysm can grow for years without a single symptom. That silence is exactly what makes it dangerous. The aorta is the body’s largest artery, carrying blood from the heart to the rest of the body, and when part of its wall weakens and bulges outward, it can grow undetected until it ruptures, which is a life-threatening emergency.
Roughly 200,000 Americans are diagnosed with an aortic aneurysm each year, and many more go undiagnosed simply because they never had a reason to get screened. At South Florida Multispecialty Medical Group, our vascular surgery team sees this condition often enough to know that early detection changes everything. Here’s what to watch for and who should be paying closer attention.
An aneurysm found early, while it’s still small, is an entirely different situation than one discovered after it has grown large or already ruptured. The gap between those two outcomes often comes down to whether someone knew to get screened in the first place.
Aortic aneurysms are generally classified by where along the aorta they occur. Abdominal aortic aneurysms, the more common type, form in the section of the aorta that runs through the belly. Thoracic aortic aneurysms occur higher up, in the portion of the aorta that passes through the chest.
The two types share some risk factors but can behave differently. Thoracic aneurysms are more closely linked to genetic connective tissue conditions and can sometimes affect younger patients, while abdominal aneurysms are more strongly tied to smoking, atherosclerosis, and age. Regardless of location, the underlying danger is the same: a weakened section of the vessel wall that can rupture without warning if it grows too large.
Most abdominal aortic aneurysms cause no symptoms at all while they’re small. They’re frequently discovered by accident, during an imaging test ordered for a completely different reason, like a CT scan for back pain or an ultrasound for an unrelated abdominal complaint.
This is part of why aneurysms have earned a reputation as a silent condition. Unlike a heart attack or a stroke, there’s rarely a dramatic moment that sends someone to the emergency room before the aneurysm has already grown significantly. By the time symptoms show up, the aneurysm has often reached a size where treatment becomes more urgent.
When symptoms do appear, they tend to be vague enough that people mistake them for something else entirely. Watch for a deep, constant ache in the belly or side of the abdomen that doesn’t have an obvious cause. Back pain that lingers without explanation is another common complaint, especially when it’s not tied to any specific movement or injury.
Some people describe a pulsing or throbbing sensation near the belly button, which can feel almost like a heartbeat you shouldn’t be able to feel from the outside. None of these symptoms are exclusive to an aortic aneurysm, but together, or in someone with known risk factors, they’re worth having evaluated rather than dismissed.
A ruptured aortic aneurysm is a true medical emergency, and the symptoms usually arrive suddenly and severely. Sudden, intense pain in the belly or back that feels like tearing or ripping is the hallmark symptom, often far more severe than any pain the person has experienced before.
A rapid heart rate, a sudden drop in blood pressure, dizziness, or fainting can accompany the pain as the body responds to significant internal bleeding. If you or someone near you experiences this combination of symptoms, call 911 immediately rather than waiting to see if it improves. Every minute matters once a rupture begins.
Certain factors dramatically increase the odds of developing an aortic aneurysm, and knowing where you stand can help you decide whether screening makes sense even without symptoms. Smoking is the single strongest risk factor, weakening artery walls throughout the body, including the aorta. The longer someone has smoked, the higher the risk climbs.
Age also plays a major role, since aneurysms occur far more often in people over 65. Men develop abdominal aortic aneurysms more frequently than women, and having a close family member with an aneurysm meaningfully raises your own risk. High blood pressure, atherosclerosis, and a history of other vascular aneurysms round out the list of major contributing factors.
The U.S. Preventive Services Task Force specifically recommends a one-time ultrasound screening for men between 65 and 75 who have ever smoked, since this group carries the highest documented risk of a serious outcome from an undetected aneurysm.
Because aneurysms grow silently, waiting for symptoms to guide your decision to get checked often means waiting too long. Ultrasound screening is quick, painless, and highly effective at catching an aneurysm while it’s still small and manageable through monitoring rather than emergency surgery.
If you fall into a higher-risk category, whether from smoking history, age, sex, or family history, talk to your doctor about whether a one-time screening makes sense for you. Our team offers vascular imaging using ultrasound, CT angiography, and MRA to detect aneurysms and other vascular conditions long before they become emergencies.
Diagnosis usually starts with imaging rather than a physical exam alone, since a small to moderate aneurysm often can’t be felt reliably by touch, especially in patients who carry extra weight around the abdomen. Ultrasound is the most common first step because it’s fast, painless, and doesn’t involve any radiation, making it ideal for both initial screening and ongoing monitoring.
If an aneurysm is found or more detail is needed, a CT scan with contrast dye gives a much more precise picture of its size, shape, and exact location relative to nearby arteries. This level of detail matters when a surgeon is planning treatment, since the anatomy of the aneurysm often determines which repair approach is safest.
MRI and MRA, a specialized form of MRI that focuses on blood vessels, offer another option, particularly for patients who need repeated imaging over time and want to limit radiation exposure. Whichever method is used, the goal is the same: get an accurate measurement so the size and growth rate can guide the treatment timeline.
Aortic aneurysms rarely exist in isolation. Many patients with an aneurysm also have some degree of atherosclerosis elsewhere in the body, including in the arteries of the legs. If you’ve noticed leg pain, cramping, or fatigue when walking that eases with rest, it’s worth mentioning to your doctor, since it can be a sign of peripheral artery disease, a related condition that shares many of the same underlying risk factors as aortic aneurysm.
Because these conditions overlap so often, a vascular surgeon evaluating one is frequently looking for signs of the other as part of a complete assessment. Treating the whole vascular system, rather than one isolated finding, tends to produce better long-term outcomes.
Treatment depends heavily on the size of the aneurysm and how quickly it’s growing. Small aneurysms are often managed with regular monitoring through periodic imaging, along with medications to control blood pressure and reduce strain on the aorta’s weakened wall. Quitting smoking and managing cholesterol are also central to slowing progression.
Larger aneurysms, or ones growing quickly, typically need surgical repair before they reach a dangerous size. Our team offers aortic aneurysm repair tailored to each patient’s anatomy and overall health, including minimally invasive options that carry a shorter recovery than traditional open surgery.
For many patients, endovascular aneurysm repair, often called EVAR, offers a less invasive alternative to traditional open surgery. Rather than making a large incision in the abdomen, the surgeon threads a stent graft through the blood vessels using small incisions in the groin, guided by imaging to place it precisely across the weakened section of the aorta.
The stent graft reinforces the artery wall from the inside, redirecting blood flow away from the bulging area and reducing the risk of rupture. Recovery from EVAR is typically much faster than open repair, with many patients going home within a day or two rather than facing a week or more in the hospital.
Not every aneurysm is a good candidate for endovascular repair, since the shape, size, and location of the weakened section all factor into which approach is safest. Imaging studies, sometimes including an angiogram, help our vascular team map out the anatomy in detail before recommending a specific surgical plan.
Recovery timelines differ significantly between the two approaches. Patients who undergo EVAR are often walking the same day and back to most normal activities within one to two weeks. Open repair involves a longer hospital stay, typically five to seven days, and a fuller recovery that can take six to eight weeks, since the incision and internal healing take more time. Your surgeon will walk you through what to expect based on which approach fits your specific case.
Not every aneurysm needs immediate surgery. Many are found while still small and are managed for years through a schedule of regular imaging, typically every six to twelve months depending on size and growth rate. During this time, the focus shifts to controlling the factors that make an aneurysm more likely to grow or rupture.
That means strict blood pressure control, quitting smoking entirely, managing cholesterol, and staying physically active within limits your vascular surgeon recommends. It’s not simply a waiting game. It’s an active management plan designed to catch any acceleration in growth before it becomes dangerous, while avoiding surgery for as long as it remains genuinely safe to do so.
Diet plays a supporting role as well. A heart-healthy eating pattern built around vegetables, whole grains, lean protein, and limited sodium helps keep blood pressure and cholesterol in a healthier range, which in turn reduces the mechanical stress on an already weakened aortic wall. None of these changes shrink an existing aneurysm, but together they slow the pace at which it grows, which can mean the difference between years of safe monitoring and an earlier surgical timeline.
If a parent or sibling has been diagnosed with an aortic aneurysm, your own risk is meaningfully higher than someone without that family history, even if you don’t smoke or have other typical risk factors. This connection is strong enough that many vascular specialists recommend screening for first-degree relatives of anyone diagnosed with an aneurysm, regardless of age or sex.
Bringing up family history at a routine physical, rather than waiting for symptoms, gives your doctor the information needed to decide whether earlier or more frequent screening makes sense for you specifically. It’s a five-minute conversation that can meaningfully change how early a problem gets caught.
If you have any combination of risk factors, whether that’s a smoking history, age over 65, or a family member who’s had an aneurysm, it’s worth a conversation with a vascular specialist even without symptoms. If you’re already experiencing unexplained abdominal or back pain, don’t wait for it to resolve on its own before getting evaluated.
Our vascular surgery team, led by specialists including Dr. Paul Hanna, works with patients across the full spectrum of aneurysm care, from initial screening through surgical repair when it becomes necessary, and through every follow-up visit in between. You can learn more about Dr. Hanna’s background in vascular surgery here.
Aortic aneurysms don’t announce themselves clearly, which is exactly why proactive care matters so much. If you’re concerned about your risk or have symptoms that don’t have an obvious explanation, contact us to schedule an evaluation with our vascular surgery team.
Most people feel nothing at all while the aneurysm is small. When symptoms do appear, they’re often a vague, deep ache in the belly or back rather than sharp or localized pain.
Growth rates vary widely between patients, which is why regular imaging matters. Small aneurysms may grow just a few millimeters per year, while others expand more quickly and need closer monitoring or earlier intervention.
Small aneurysms are often managed with monitoring and lifestyle changes rather than immediate surgery. Surgery becomes necessary once the aneurysm reaches a size or growth rate that makes rupture a significant risk.
No. Screening is typically done with an ultrasound, which is painless, noninvasive, and takes only a few minutes to complete.
Men between 65 and 75 who have ever smoked are the group with the strongest screening recommendation, though anyone with a family history of aneurysms or other significant risk factors should discuss screening with their doctor.
Mayo Clinic, “Abdominal Aortic Aneurysm: Symptoms and Causes”
U.S. Preventive Services Task Force, “Abdominal Aortic Aneurysm: Screening”
Dr. Paul Hanna is a board-certified vascular surgeon with specialized fellowship training in complex vascular interventions and minimally invasive endovascular techniques. He serves as Director of Vascular Surgery and General Surgery at South Florida Multispecialty Medical Group, with over a decade of experience treating vascular conditions affecting the limbs, aorta, and peripheral arterial system.
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