An abdominal aortic aneurysm — a dangerous bulging of the body's largest artery — ruptures without warning in tens of thousands of people every year. Most of them had no idea it was there. A simple 30-minute ultrasound can find it. Here's what you need to know.
By Emanuel Papadakis, RDCS, RVT
Medically reviewed by Dr. Glenn Gandelman, MD, MPH, FACC, FASE — Board-Certified Cardiologist
January 2025
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An abdominal aortic aneurysm is a silent killer. The aorta, the largest artery in the body, runs through the abdomen and supplies blood to virtually every organ below the heart. When a section of the aortic wall weakens and expands, forming an aneurysm, there are typically no symptoms until the aneurysm ruptures. At that point, the mortality rate is 50 to 80 percent. The test that detects it takes 30 minutes and involves no radiation.
What an Aortic Aneurysm Is
An aneurysm is a permanent localized dilation of an artery to more than 1.5 times its normal diameter. In the abdominal aorta, a diameter greater than 3.0 centimeters is considered aneurysmal. Aneurysms grow slowly, typically 0.3 to 0.5 centimeters per year in the early stages, and the rate of expansion accelerates as the aneurysm enlarges. Risk of rupture increases dramatically once the diameter exceeds 5.5 centimeters.
The aortic wall weakens due to a combination of atherosclerosis, chronic inflammation, and degradation of the structural proteins elastin and collagen. These changes accumulate over decades and are directly linked to the same risk factors that drive coronary artery disease and stroke. Smoking is the strongest modifiable risk factor for AAA and dramatically accelerates both aneurysm growth and rupture risk.
Why the USPSTF Recommends Screening
The United States Preventive Services Task Force has recommended one-time AAA screening for men aged 65 to 75 who have smoked 100 or more cigarettes in their lifetime.[2] This recommendation is based on randomized controlled trial evidence showing that screening in this population reduces AAA-related death by 43 percent.[1]
The recommendation applies to men because AAA is four to six times more common in men than women.[3] However, women who have smoked have a substantially elevated risk compared to non-smoking women, and the consequences of a ruptured AAA in women tend to be worse due to smaller aortic size and more rapid expansion. Evidence increasingly supports screening for women with significant smoking history.
Medicare covers one-time AAA screening for qualifying men. For individuals not covered by this benefit, the test is available at BlackPoint for $397, which is substantially less than most insurance copays for hospital-based imaging.
What the Screening Looks For
An AAA screening ultrasound measures the maximum anteroposterior diameter of the infrarenal aorta, the segment below the renal arteries where aneurysms most commonly occur. The measurement is taken at the widest point. A normal aorta measures less than 3.0 centimeters. Measurements are classified as small aneurysm (3.0 to 3.9 cm), medium aneurysm (4.0 to 5.4 cm), or large aneurysm (5.5 cm and above).
The scan also assesses the iliac arteries, which can develop separate aneurysms, and evaluates aortic wall characteristics including thrombus formation within the aneurysm sac. Thrombus does not protect against rupture and is a marker of chronic aneurysm activity.
What Happens If an Aneurysm Is Found
›Small aneurysm 3.0 to 3.9 cm: surveillance with repeat imaging every two to three years, risk factor modification, smoking cessation is critical
›Medium aneurysm 4.0 to 5.4 cm: more frequent surveillance every 6 to 12 months, vascular surgery consultation when approaching 5.0 cm
›Large aneurysm 5.5 cm and above: vascular surgery referral for elective repair, which carries 1 to 2 percent mortality versus 50 to 80 percent for emergency rupture repair[3]
›Symptomatic aneurysm regardless of size: urgent evaluation, as new back or abdominal pain in the presence of an aneurysm can indicate impending rupture
Who Should Be Screened
›Men 65 to 75 with any smoking history of 100 or more cigarettes
›Men over 55 with a first-degree relative who had an aortic aneurysm
›Women over 65 with significant smoking history
›Anyone with known peripheral artery disease or coronary artery disease
BlackPoint performs AAA screening at your home in 30 minutes. No preparation required. Written cardiologist report in 24 to 48 hours. $397, no referral required. This is one of the highest-yield screening tests available for the populations listed above.
Ashton HA, Buxton MJ, Day NE, et al. "The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial." Lancet, 2002. PMID: 12443589
US Preventive Services Task Force. "Screening for Abdominal Aortic Aneurysm: US Preventive Services Task Force Recommendation Statement." JAMA, 2019. PMID: 31821437
Thompson SG, Ashton HA, Gao L, et al. "Final follow-up of the Multicentre Aneurysm Screening Study (MASS) randomized trial of abdominal aortic aneurysm screening." Br J Surg, 2012. PMID: 23034729
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