What is an aortic aneurysm?

An aortic aneurysm is a permanent abnormal bulging or widening of the aorta — the body's main artery — to at least 1.5 times its normal diameter. Abdominal aortic aneurysm (AAA): the most common and clinically important type — affects the aorta below the renal arteries; defined as aortic diameter ≥3.0cm (normal approximately 2.0cm). Thoracic aortic aneurysm (TAA): affects the ascending or descending thoracic aorta — often associated with bicuspid aortic valve, Marfan syndrome or hypertension. Aneurysms are dangerous because they can rupture — causing catastrophic internal bleeding with >80% fatality — or produce emboli (blood clots that travel to the legs or kidneys) or cause compression of adjacent structures.

Why doesn't AAA cause symptoms?

The vast majority of abdominal aortic aneurysms are entirely asymptomatic until rupture — the first symptom in many patients. This is because the aorta is a large, distensible vessel deep in the abdomen — even significant enlargement may cause no pain or discomfort. When symptoms do occur: back pain or abdominal pain (may indicate rapid expansion or contained leak); pulsatile abdominal mass (a throbbing bulge felt above the navel — relatively specific but often missed). The sudden severe "tearing" pain radiating to the back that characterises aortic dissection is distinctly different from the typical aneurysm presentation. Incidental discovery on ultrasound (for another indication) or on AAA screening is the most common way AAAs are found before rupture.

Who should be screened for AAA?

NHS England: all men aged 65 are invited for a one-time abdominal ultrasound — a 10-minute scan that safely and accurately measures the aortic diameter. US USPSTF: one-time ultrasound screening for all men 65-75 who have ever smoked (smoked at least 100 cigarettes). Earlier screening (from age 55) or additional screening rounds are recommended for: first-degree male relative with AAA (2.5× higher risk); personal history of other aneurysm (popliteal, femoral, iliac). Women are not routinely screened in most programmes (lower prevalence) — but women with strong risk factors (smoking, family history) may benefit from targeted screening from age 65.

What happens if an AAA is found?

The management depends on the diameter: Small AAA (3.0-4.4cm): surveillance ultrasound annually — monitor for growth. Intermediate AAA (4.5-5.4cm): surveillance ultrasound every 3 months — more rapid growth surveillance. Large AAA (≥5.5cm in men / ≥5.0cm in women): referral to a vascular surgeon for assessment of elective repair. At all stages: smoking cessation (the most important intervention for slowing growth); optimal blood pressure control (target 20-25kg. Elective repair (EVAR or open) is planned when rupture risk exceeds operative risk.

What is the difference between EVAR and open surgery?

Both achieve the same goal: excluding the aneurysm from aortic blood pressure, preventing rupture. EVAR (endovascular aortic repair): a stent-graft is deployed via keyhole access in both groins — no large abdominal incision. Advantages: lower 30-day mortality (<1%); shorter hospital stay (2-5 days vs 7-10 for open); faster return to normal activity. Disadvantages: requires lifelong CT surveillance (every 1-2 years) to detect endoleak or graft problems; some anatomy is not suitable; may need re-intervention over decades. Open surgical repair: large abdominal or retroperitoneal incision; direct sewing of a Dacron graft; hospital 7-10 days; 3-5% 30-day mortality; but very durable (20-25+ years without re-intervention) and no lifelong CT surveillance required. Choice: patient-dependent (anatomy, fitness, age, preference).

How does GMJ News cover aortic aneurysm?

GMJ News covers AAA screening (men 65, ultrasound), rupture mortality (80%) vs elective EVAR (<1%), smoking as #1 modifiable risk factor, diameter surveillance thresholds, EVAR vs open repair, endoleak surveillance, aortic dissection Stanford A (emergency) vs B, Marfan syndrome and hereditary aortopathy, and DeBakey/Stanford classification. Aortic aneurysm and dissection are directly relevant to PHIG's cardiovascular emergency programme and Georgia's vascular surgery capacity.

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Aortic Aneurysm

Q: How does GMJ News cover aortic aneurysm?

GMJ News covers AAA screening (men 65, ultrasound), rupture mortality (80%) vs elective EVAR (<1%), smoking as #1 modifiable risk factor, diameter surveillance thresholds, EVAR vs open repair, endoleak surveillance, aortic dissection Stanford A (emergency) vs B, Marfan syndrome and hereditary aortopathy, and DeBakey/Stanford classification. Aortic aneurysm and dissection are directly relevant to PHIG's cardiovascular emergency programme and Georgia's vascular surgery capacity.

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

Aortic aneurysm — permanent pathological dilation of the aorta to ≥50% of its normal diameter, most commonly abdominal (AAA, involving the infrarenal aorta, normal diameter approximately 2cm, aneurysm threshold ≥3cm or ≥5.5cm for repair) — is predominantly caused by atherosclerosis and tobacco smoking (the strongest modifiable risk factor), affects approximately 5-8% of men over 65 in most high-income countries, and has a case fatality rate exceeding 80% if it ruptures — yet is entirely asymptomatic until rupture in the vast majority of cases, making population-based screening one of the most cost-effective cardiovascular prevention interventions available (WHO). One-time ultrasound screening of men aged 65 — offered by NHS England, US Preventive Services Task Force (ever-smokers) and many other programmes — detects AAAs before rupture, enabling elective repair (endovascular — EVAR — or open surgical) with markedly lower mortality than emergency rupture repair.

Key messages

AAA screening — one-time ultrasound at 65 saves lives

One-time abdominal ultrasound screening for AAA in men aged 65 is one of the most cost-effective cardiovascular prevention interventions available. NHS AAA screening programme (UK) reduces AAA-related mortality by approximately 40% in invited men. US USPSTF: recommends one-time screening for men 65-75 who have ever smoked. Detected small AAAs are placed under surveillance; large AAAs (≥5.5cm) are referred for elective repair.

Rupture kills 80%+ — elective repair mortality <5% EVAR

Ruptured AAA carries a case fatality rate exceeding 80% (most die before reaching hospital or during emergency surgery). Elective endovascular repair (EVAR): <1% 30-day mortality in selected patients at specialist centres. This mortality gap — 80% vs <1% — is the rationale for surveillance and elective repair before rupture.

Smoking — the single most important modifiable risk factor

Tobacco smoking is the dominant modifiable risk factor for AAA — with current smokers having approximately 5-7× higher AAA prevalence than never-smokers. AAA risk increases with pack-year exposure. Smoking cessation is the most evidence-based intervention for slowing aneurysm growth rate. All patients diagnosed with AAA must receive cessation support. Other risk factors: male sex (~6× higher); age >65; family history (first-degree relative); hypertension; dyslipidaemia.

EVAR vs open repair — the evidence

EVAR (endovascular aortic repair): stent-graft deployed via femoral artery access under X-ray guidance — no open abdominal incision; shorter hospital stay; faster recovery; lower 30-day mortality; but requires lifelong CT surveillance (endoleak, graft migration). Open surgical repair: durable 25+ years; one-time surveillance CT; higher 30-day mortality (3-5%) but equivalent or superior long-term survival at 5+ years. Choice: EVAR for anatomically suitable AAA in patients with higher operative risk; open repair for younger fit patients and those with anatomy not suitable for EVAR.

TAD — aortic dissection — the acute emergency

Aortic dissection: intimal tear → blood enters and propagates through the aortic wall. Type A (ascending aorta — immediate surgical emergency); Type B (descending aorta — medical management with beta-blockers and BP control, endovascular intervention for complicated cases). Classic presentation: sudden, severe, tearing or ripping chest/back pain, often radiating to the back; may have pulse deficit, aortic regurgitation, or neurological symptoms. CT aortography is the diagnostic standard.

Marfan syndrome and hereditary aortopathy

Younger patients with aortic aneurysm (particularly ascending aorta/root) should be screened for hereditary aortopathy: Marfan syndrome (FBN1 mutations — tall stature, arachnodactyly, lens dislocation); Loeys-Dietz syndrome (TGFBR1/2 — particularly aggressive aortic phenotype); bicuspid aortic valve (associated with ascending aortic dilation in approximately 20-30%). MRI/CT aortography + genetic testing + family cascade screening.

Key statistics

5-8%

of men over 65 in HICs have AAA (aortic dilation ≥3cm)

NHS/USPSTF

>80%

case fatality rate of ruptured AAA

ESC/NHS

<1%

elective EVAR 30-day mortality at specialist centres vs >50% emergency repair

ESC/NICE

5-7×

higher AAA risk in current smokers vs never-smokers

ESC/NICE

≥5.5cm

AAA diameter threshold for elective repair (men); ≥5.0cm for women

ESC 2024

40%

reduction in AAA mortality from NHS screening programme

MASS trial/NHS

AAA diameter and annual rupture risk — ESC 2024

Source: ESC 2024. Rupture risk rises steeply above 5.5cm; elective repair threshold balances rupture vs operative risk.

Glossary of key terms

AAA — definition and measurement
ESC/VascularAbdominal aortic aneurysm: permanent dilation of the abdominal aorta ≥50% of the normal diameter — in practice, a diameter ≥3.0cm on ultrasound (normal infrarenal aorta approximately 2.0cm in men). Measured as maximum external antero-posterior diameter perpendicular to the aortic axis on ultrasound. Surveillance intervals by diameter: 3.0-4.4cm: annual ultrasound; 4.5-5.4cm: 3-monthly ultrasound; ≥5.5cm: referral for vascular surgery assessment. Women have smaller aortic diameters — some guidelines use ≥5.0cm as repair threshold for women.

EVAR (endovascular aortic repair)
ESVS/ESCA minimally invasive procedure: a stent-graft (a fabric tube supported by a metal frame) is deployed via bilateral femoral artery access using fluoroscopic (X-ray) guidance, positioning the device to exclude the aneurysm sac from aortic blood flow pressure. Advantages: no abdominal incision; lower 30-day mortality; faster recovery. Limitations: requires appropriate aortic anatomy (adequate "landing zones" — non-aneurysmal aortic neck above and iliac arteries below); endoleak risk (blood continuing to enter the aneurysm sac around or through the graft — requires lifelong CT surveillance every 1-2 years); device failure/migration over decades.

Aortic dissection — Stanford classification
Vascular/SurgeryStanford type A (involves the ascending aorta — regardless of where the intimal tear is): SURGICAL EMERGENCY — mortality increases by approximately 1-2% per hour without surgery. Surgical repair: emergency replacement of the ascending aorta. Stanford type B (only the descending aorta, distal to the subclavian artery origin): medical management: IV beta-blockers (rate and pressure control — target HR <60, SBP 100-120 mmHg) + analgesics; uncomplicated type B: medical management; complicated type B (malperfusion — ischaemia of kidney, gut, limbs — or refractory pain or rapid expansion): endovascular repair (TEVAR — thoracic endovascular aortic repair).

DeBakey classification
Vascular/SurgeryAlternative aortic dissection classification: Type I (ascending + descending); Type II (ascending only — both Stanford A); Type III (descending only — Stanford B). Type IIIa (descending thoracic only); Type IIIb (descending thoracic + abdominal). Stanford classification is more widely used clinically — the key binary distinction (Stanford A = surgical emergency) drives immediate management.

AAA surveillance intervals
ESC 2024/NICENHS AAA screening programme (England) and ESC 2024 guidelines: ≥3.0cm to 4.4cm: annual surveillance ultrasound. 4.5-5.4cm: 3-monthly surveillance. ≥5.5cm (men) / ≥5.0cm (women): vascular surgery referral for consideration of elective repair. Surveillance is critical — AAA growth rate is approximately 2-3mm/year on average (faster in smokers, hypertensives); growth rate >5mm in 6 months indicates more rapid expansion and earlier surgical assessment. CT angiography required before repair planning.

Endoleak — the EVAR-specific complication
Radiology/VascularBlood continuing to flow into the aneurysm sac after EVAR — detected on CT surveillance. Five types: Type I (attachment site leak — most serious; requires re-intervention); Type II (collateral vessel backflow from lumbar or inferior mesenteric arteries — most common; often benign; treat if AAA sac expands); Type III (graft defect or component separation — re-intervention required); Type IV (graft porosity — self-limiting); Type V (endotension — sac pressure without visible leak). Lifelong CT surveillance (typically every 1-2 years) is mandatory after EVAR to detect endoleak and sac expansion — a major difference from open repair (which requires less intensive long-term follow-up).