Abdominal aortic aneurysm (AAA): NHS screening for men at 65 and what results mean

The NHS describes an abdominal aortic aneurysm as a swelling in the aorta, the artery that carries blood from the heart to the abdomen. Most aneurysms cause no problems but can be serious because they could burst. The British Heart Foundation explains that the aortic wall must resist the pressure of blood pumped from the heart while remaining flexible, and that an aneurysm usually occurs where a part of the wall has become weakened or cannot stretch as well as it should. It says the abdomen is the most common place, with thoracic aortic aneurysm occurring in the chest less often, and that the bigger the aneurysm the higher the risk of rupture.

The NHS lists being male and aged 65 or over, smoking now or in the past, high blood pressure, high cholesterol, a close relative who has had an AAA, coronary or peripheral artery disease (atherosclerosis), COPD, and conditions such as Marfan syndrome. The BHF lists age, sex (more men than women), high blood pressure, smoking, atherosclerosis, family history and genetic conditions such as Marfan syndrome. Rarely an infection is responsible.

AAA screening is not usually offered to men under 65, to women, or to people who have already had treatment for an AAA, the NHS says. If you are not eligible but think you are at higher risk, for example because of family history, high blood pressure, diabetes, COPD or smoking, the NHS suggests talking to a GP about the possibility of a scan.

During the year you turn 65 you receive a letter with a pre-booked appointment, which the NHS says is usually sent 3 to 6 weeks before. Screening usually takes place at GP surgeries or health centres, and sometimes hospitals. If you have not had an invitation and think you should have, contact your local AAA screening service; if you are registered as female with a GP but were assigned male at birth, you may need to ask the surgery or the service for an appointment. It is your choice whether to attend (you can decline by calling the service, and call again later if you change your mind), and the NHS says that because most aneurysms have no symptoms, screening is the best way to find one.

You have the test once unless an aneurysm is found. The scan uses a handheld probe on the tummy; sometimes a clear picture is not possible and another scan is needed. The result is given at the end, and your GP surgery is sent the results.

If no aneurysm is found, nothing further is needed and no more scans follow. If one is found, the next step depends on its size.

The NHS says treatment depends on size and symptoms. Small aneurysms may need lifestyle changes such as quitting smoking and eating healthily to help stop them growing; medicines to lower blood pressure and cholesterol may help. Surgery to reduce the risk of bursting may be done if the AAA is large (5.5cm or bigger), growing quickly or painful, and surgery has risks and side effects that the surgeon should discuss. The BHF says that if an aneurysm grows to around 5.5cm you may need surgery to prevent it bursting. For an older person with other illnesses, the vascular team considers the individual balance of risk and benefit, and the type of repair may differ.

The specialist nurse for small and medium aneurysms talks about medicines, more frequent blood pressure checks, and things that can slow growth, including stopping smoking, losing weight if overweight and a healthy balanced diet.

The NHS says that if an aneurysm gets bigger you might notice tummy or back pain or a pulsing feeling in the tummy, and to see a GP for tummy or back pain that does not go away or keeps coming back, or a lump in the tummy, though these have many other causes. The BHF adds persistent back pain.

The NHS says to call 999 for sudden severe pain in the tummy or back, struggling to breathe, pale or grey skin (which may be easier to see on the palms or soles on brown or black skin) or loss of consciousness, as these could be signs of a rupture, a life-threatening emergency needing hospital treatment as soon as possible. The BHF lists feeling cold, clammy, sweaty, faint and breathless, and adds that sudden severe chest pain spreading to the back is a feature of aortic dissection, also a 999 emergency.