Aortic aneurysm: symptoms, screening, treatment and when it is an emergency

The NHS says an abdominal aortic aneurysm often has no symptoms. You usually only find out you have one during a screening test or during tests for another condition. The British Heart Foundation (BHF) agrees that in most cases there are no noticeable symptoms and most people with an aneurysm will not know they have one.

If an aneurysm gets bigger you might notice the following. The NHS stresses that these symptoms have many other causes and do not mean you have an aneurysm, but are best checked.

• Tummy or back pain that does not go away or keeps coming back.

• A pulsing or throbbing feeling in your tummy.

• A lump in your tummy (the NHS says to see a GP).

• Dull or severe stomach pain, or persistent back pain (BHF).

A rupture is a life-threatening emergency that needs treatment in hospital as soon as possible. The NHS says to call 999 if you or someone else has any of the following. The BHF adds feeling cold, clammy, sweaty and faint to its list of warning symptoms.

• Sudden, severe pain in the tummy or back.

• Struggling to breathe or having stopped breathing.

• Pale or grey skin. On brown or black skin this may be easier to see on the palms of the hands or soles of the feet.

• Losing consciousness, fainting or passing out.

The aorta is the main artery in the body. The BHF explains that it carries blood high in oxygen from the heart to the rest of the body. An aneurysm is a swelling or bulging at any point along it, and the type is named by where it occurs.

An abdominal aortic aneurysm (AAA) is in the tummy area and is the most common. A thoracic aortic aneurysm is where the aorta passes through the chest. An aneurysm usually forms where part of the aortic wall has become weakened or cannot stretch as well as it should.

The danger is rupture. The BHF describes it as a significant tear in all the layers of the aorta wall in a large aneurysm, letting blood leak out and leading to severe blood loss. The bigger the aneurysm, the higher the risk of rupture, which is why aneurysms are ideally repaired before this can happen.

NHS England says AAA screening is offered to men during the screening year (1 April to 31 March) in which they turn 65, because men aged 65 and over are most at risk. Men who live in England receive a postal invitation when they are aged 64 or 65. Men over 65 who have not received an invitation can contact their local AAA screening service to make an appointment.

Screening is not routinely offered to men under 65, to women or to anyone who has already been treated for an AAA. Women, or men under 65 who think they are at higher risk, for example because of a family history, can talk to their GP about having a scan outside the screening programme. It is each person's choice whether to take part.

The screening test is an ultrasound scan of the tummy. NHS England says it is quick and painless, usually takes about 10 to 15 minutes, and you are told your result straight away. The four possible results are no aneurysm, small, medium or large.

The NHS says the main test is an ultrasound scan of your tummy. A small device is placed on your tummy and images appear on a screen. You will usually be told at the end of the test if you have an aneurysm and how big it is.

The BHF adds that an aneurysm is sometimes picked up during tests for other conditions, commonly by CT scan, MRI scan or ultrasound, and that a CT scan can be requested to assess an aneurysm's size and location.

The NHS says treatment usually depends on how big the aneurysm is and whether you have symptoms. The BHF says it also depends on the location. If it is small, lifestyle changes such as quitting smoking and eating healthily may be recommended to help stop it getting bigger.

Sometimes you may need medicines to lower your blood pressure and cholesterol level, which may help stop the aneurysm getting bigger, or surgery to reduce the risk of it bursting. The NHS says surgery may be done if your AAA is large (5.5cm or bigger), is quickly getting bigger or is painful. The BHF similarly says that if an aneurysm grows beyond around 5.5cm you may need surgery to prevent it from bursting.

Aneurysms often get bigger over time, so the NHS says you will usually need regular scans to see whether it is growing. Surgery has risks and side effects, which your doctor or surgeon should discuss with you. If an aneurysm ruptures, emergency surgery is needed.

The NHS says it is not always clear what causes an aneurysm, but the aorta becomes weakened and some people have a higher chance of getting one. The BHF says there is no specific cause, but lists age, being male, high blood pressure, smoking, atherosclerosis, a family history and genetic conditions such as Marfan syndrome as risk factors.

• Being male and aged 65 or over.

• Smoking now or in the past.

• High blood pressure or high cholesterol.

• A close relative who has had an abdominal aortic aneurysm.

• Coronary or peripheral artery disease (atherosclerosis) or chronic obstructive pulmonary disease (COPD).

• A condition such as Marfan syndrome. Sometimes an AAA is caused by an infection, but this is rare (NHS).

The NHS says healthy lifestyle changes can help lower your risk of getting an abdominal aortic aneurysm, or stop one getting bigger. It advises that you eat healthily, exercise regularly, try to lose weight if you are overweight and try to cut down on alcohol, and that you do not smoke.

The BHF describes aortic dissection as when the weakened wall of the aorta tears, letting blood leak between the layers of the wall. Having an aortic aneurysm puts you at higher risk. Symptoms include sudden severe pain across the chest, often felt in the back or between the shoulder blades, feeling cold, clammy and sweaty, and fainting and shortness of breath.

The BHF says that anyone with these symptoms should phone 999 immediately because dissection is a medical emergency.

On the NHS, AAA screening, follow-up scans and surgery are provided through the screening programme, your GP and hospital vascular services. Emergency rupture is treated through 999 and A&E.

Private clinics can offer ultrasound or CT scans and specialist opinions for people outside the screening programme, such as women or younger people with a strong family history. If you go that way, ask how an aneurysm would be re-measured over time, because it needs repeat measurement rather than a one-off scan.