7 Signs You May Need Aneurysm Screening

By Emanuel Papadakis, RDCS, RVT  |  June 7, 2026  |  Preventive Screening

Most abdominal aortic aneurysms produce zero symptoms until rupture. But certain risk factors and physical signs significantly increase your likelihood of having one. Here are seven signs that screening is worth pursuing.

Why AAA Is Called the "Silent Killer"

The abdominal aorta is the largest artery in the body. When its wall weakens and begins to expand, it does so without pain, pressure, or any sensation at all — in most people, for most of its growth. An aneurysm can develop over years and reach a dangerous size without a single warning sign.

Once it ruptures, the mortality rate is up to 80%. Most ruptures happen before the person ever knew they had an aneurysm. That is the core problem screening solves: it finds the aneurysm while there is still time to monitor or intervene. For a full explanation of what an AAA is and how it forms, see our detailed overview.

Sign 1: You're a Man Over 65 Who Has Smoked

This is the single group with the strongest evidence for screening. The U.S. Preventive Services Task Force issues a Grade B recommendation — meaning significant benefit with high certainty — for one-time AAA screening in men aged 65 to 75 who have ever smoked.

"Ever smoked" is defined as 100 or more cigarettes in your lifetime. This includes people who quit decades ago. The damage smoking does to arterial walls is cumulative and long-lasting. Quitting reduces ongoing risk, but it does not erase the structural changes already present.

If you are male, 65 or older, and have smoked at any point in your life, a one-time ultrasound is a straightforward and evidence-based step.

Sign 2: Family History of Aortic Aneurysm

A first-degree relative — parent, sibling, or child — with a history of abdominal aortic aneurysm roughly doubles your own risk. The underlying mechanisms involve inherited connective tissue quality, inflammatory response patterns, and the same vascular risk factors that tend to run in families.

If you have a family history of AAA, screening may be appropriate beginning at age 55 rather than waiting until 65. This is worth discussing with your physician, particularly if other risk factors are also present. Family history alone, without other risk factors, still warrants a conversation — not dismissal.

Sign 3: You Have High Blood Pressure or Atherosclerosis

Chronic hypertension exerts persistent mechanical stress on arterial walls. Over years, this weakens the structural integrity of the aorta and accelerates the degeneration of the medial layer — the same process that allows an aneurysm to form. Uncontrolled or long-standing hypertension is an independent risk factor for AAA, separate from smoking.

Atherosclerosis — the buildup of plaque in arterial walls — is a systemic disease. If you have been told you have plaque in your carotid arteries or evidence of peripheral artery disease in your legs, the same inflammatory and degenerative process is very likely affecting your aorta as well. Vascular disease rarely announces itself in only one location.

Sign 4: You Feel a Pulsing Sensation in Your Abdomen

A pulsatile mass in the abdomen is the most common physical finding associated with a large abdominal aortic aneurysm. You may feel it yourself as a rhythmic throbbing near the navel, particularly when lying flat. In some cases, a physician can palpate it during an exam.

That said, not every pulsing sensation indicates an aneurysm. Thin individuals can feel a normal aortic pulse without any enlargement. The distinction between a normal pulse and a pulsatile mass requires imaging — a physical exam alone is not sufficient to rule out or confirm an aneurysm. If you have noticed unexplained abdominal pulsing and have other risk factors, ultrasound is the appropriate next step.

Sign 5: Unexplained Back or Abdominal Pain

Deep, constant back pain or a persistent dull ache in the abdomen that does not resolve with rest can, in some cases, indicate a growing aneurysm pressing on adjacent structures. This is more common as the aneurysm reaches a larger size and begins to affect surrounding tissue.

Back pain is extraordinarily common and has many causes unrelated to the aorta. This sign is most relevant when it is present alongside other risk factors listed here — particularly in an older man with a smoking history. Unexplained abdominal or back pain in that context warrants imaging, not watchful waiting.

Sign 6: You Have a Connective Tissue Disorder

Certain inherited conditions directly affect the structural integrity of connective tissue throughout the body, including in arterial walls. Marfan syndrome, Ehlers-Danlos syndrome (particularly the vascular subtype), and Loeys-Dietz syndrome significantly increase the risk of aortic aneurysm — often at younger ages than the general population and in locations beyond just the abdominal aorta.

A bicuspid aortic valve — a congenital condition in which the aortic valve has two leaflets instead of three — is associated with progressive dilation of the ascending aorta and increased aneurysm risk. An echocardiogram can identify a bicuspid valve and assess the aortic root and ascending aorta. If you have been told you have any of these conditions, aortic surveillance imaging is not optional — it is a standard part of long-term management.

Sign 7: You've Had an Aneurysm Found Elsewhere

Aneurysms do not always develop in isolation. If imaging has previously identified an aneurysm in another location — the thoracic aorta, a popliteal artery behind the knee, or the iliac arteries — screening the abdominal aorta is a reasonable and prudent step. The same risk factors that produce an aneurysm in one arterial segment are frequently present throughout the vascular system.

This is particularly relevant for popliteal aneurysms, which carry a known association with abdominal aortic aneurysm. If you or your physician are aware of an aneurysm elsewhere, the abdominal aorta deserves evaluation.

What AAA Screening Involves

An AAA screening ultrasound is among the simplest studies I perform. You lie flat on your back. I apply gel to your abdomen and use a handheld transducer to image the aorta from multiple views, measuring its diameter at several key points. The entire exam takes approximately 15 minutes. There is no radiation, no contrast dye, and no discomfort.

The one preparation required is fasting for 4 to 6 hours beforehand. Abdominal gas is the primary obstacle to clear aortic imaging, and an empty stomach produces consistently better results.

Results are reviewed by a board-certified cardiologist and returned to you within 48 hours with a clear explanation of findings. For a complete overview of the screening process, eligibility criteria, and what different results mean, see our AAA screening guide. Our mobile service brings the exam to your home or preferred location throughout Southern Maine — no hospital, no referral, no waiting weeks for an appointment.

When to Act

If any of these seven signs apply to you, screening takes 15 minutes and could be the most consequential 15 minutes of your year. The defining feature of an abdominal aortic aneurysm is that, by definition, it does not produce symptoms until it is already dangerous or rupturing. Waiting to feel something before getting screened is, in practical terms, waiting too long.

The goal of screening is to find an aneurysm when it is small, when the options are surveillance and risk-factor management rather than emergency surgery. That window exists — but only if you use it. To learn more about our AAA screening service in Southern Maine, visit our AAA service page.