Aneurysms: The Silent Risk That Screening Can Catch

What is an aneurysm?

An aneurysm is an abnormal bulge that forms when the wall of an artery weakens and stretches outward. The danger is that a growing aneurysm can eventually rupture, causing severe internal bleeding. An abdominal aortic aneurysm — a bulge in the section of the aorta running through the abdomen — is the most common type and the focus of most screening.

Why are aneurysms so dangerous if they don't cause symptoms?

Aneurysms are dangerous precisely because they're usually silent — most people have no idea they have one until it grows large or ruptures. A ruptured abdominal aortic aneurysm is a catastrophic, often fatal emergency. The good news is that an aneurysm found before it ruptures can be monitored safely and repaired electively, turning a potential emergency into a planned, controlled procedure with far better outcomes.

Who should be screened for an abdominal aortic aneurysm?

National guidelines recommend a one-time screening ultrasound for men aged 65 to 75 who have ever smoked, because they're at the highest risk. Screening is also reasonable to consider for other older adults with risk factors, such as a family history of aneurysm. The screening itself is a quick, painless ultrasound of the abdomen — no needles, no preparation, no radiation.

If you're in this group and have never been screened, it's one of the simplest, highest-value tests you can have.

What causes an aneurysm, and who is at risk?

Aneurysms develop from a combination of artery-wall weakening and risk factors. The strongest contributors are:

• Smoking — the single most important and most modifiable risk factor for AAA
• Age over 65
• Being male (though aneurysms affect women too, and can be more dangerous when they occur)
• A family history of aneurysm
• High blood pressure and atherosclerosis (hardening of the arteries)

How are aneurysms treated?

Treatment depends entirely on the aneurysm's size and how fast it's growing — and for many people, the answer is careful monitoring rather than immediate surgery.

• Surveillance (watchful waiting): Small aneurysms have a very low risk of rupture and are simply monitored with periodic ultrasounds to track any growth. Most aneurysms found through screening fall into this category. Controlling blood pressure and stopping smoking help slow growth.
• Repair: When an abdominal aortic aneurysm reaches roughly 5.5 cm in men (somewhat smaller in women), grows rapidly, or causes symptoms, repair is recommended to prevent rupture. There are two approaches:
  • Endovascular aneurysm repair (EVAR) — a minimally invasive procedure that reinforces the aorta from the inside using a stent graft placed through small access points, now the more common approach.
  • Open surgical repair — a traditional, durable repair that may be the better choice for certain aneurysm shapes or anatomy.

As a board-certified vascular surgeon, Dr. Cardentey evaluates each aneurysm individually and recommends the approach — including continued monitoring — that fits the patient's anatomy and overall health.

What about aneurysms in other arteries?

Aneurysms can also form in other arteries, including behind the knee (popliteal aneurysms) and in the chest portion of the aorta (thoracic aneurysms). Popliteal aneurysms matter to the legs because, rather than rupturing, they tend to throw off clots that can threaten the limb. These are evaluated and managed by the same vascular expertise, and finding one aneurysm is a reason to check for others.