The aorta is the main artery carrying blood away from the heart. Its abdominal section runs through the tummy, gives branches to organs including the kidneys and bowel, and divides into arteries supplying the legs. An abdominal aortic aneurysm is a local widening of this artery where the wall has weakened. Most people feel nothing, so an aneurysm is often found on screening or a scan for another reason.

As the weakened wall stretches, the aneurysm can enlarge and eventually tear, allowing blood to escape into the abdomen. This is rupture, a life-threatening haemorrhage. Larger aneurysms are generally more likely to rupture, but growth is unpredictable and size alone does not tell an individual exactly when or whether rupture will occur.

An aneurysm is a widening of the artery, distinct from an artery blockage or an aortic valve problem. Repair aims to provide a strong new route for blood through the affected section and reduce pressure on the weakened wall. It cannot remove every future vascular risk, and the details depend on the aneurysm’s position and the technique used.

Risk is associated with age, smoking or previous smoking, high blood pressure, vascular disease, COPD and a close family history. Some inherited connective tissue conditions are also associated with AAA; infection is a rare cause. A risk factor does not prove the cause of any one person’s aneurysm. Tell close relatives about your diagnosis so they can ask a GP whether assessment is appropriate.

Screening is an invitation to look for an aneurysm before symptoms appear. In England men are invited in the year they turn 65. Screening is recommended for anyone assigned male at birth; a person registered female with their GP may need to contact their GP or local screening service rather than receive an automatic invitation. Men aged 66 or older who have not been screened can ask about self-referral. Screening is a choice.

The four UK nations run their own screening programmes. Check the linked Scotland, Wales or Northern Ireland service for local eligibility, invitations and how to arrange an appointment. Screening programmes do not routinely invite everyone who could develop an AAA. Anyone outside the routine invitation group who has a family history or other concern can discuss an individual assessment with a GP.

A scan arranged for a symptom or an identified risk is diagnostic assessment, rather than a reason to wait for a screening invitation. NICE recommends considering ultrasound for women aged 70 or over with specified risk factors when an AAA has not already been excluded on abdominal imaging. It also recommends ultrasound when an asymptomatic AAA is suspected. Symptoms or concern about rupture require a different, urgent pathway.

Ultrasound uses a probe on the abdomen to measure the aorta and does not use X-rays. Images are sometimes unclear and a repeat scan may be needed. NICE specifies the maximum front-to-back diameter measured inner-to-inner on ultrasound; ask which measurement was used when comparing reports, as different methods can produce different numbers.

For elective repair planning, NICE recommends contrast-enhanced CT angiography to show the aorta, its branches and access arteries in detail. In suspected rupture, bedside ultrasound and immediate vascular discussion can help rapidly assess the situation; CT may help plan repair, but some people need immediate transfer without waiting for it. Tell the team about kidney disease or previous contrast reactions.

An asymptomatic aneurysm can be monitored with ultrasound rather than operated on immediately. In the NHS England screening programme, a 3.0 to 4.4 cm AAA is generally scanned yearly and a 4.5 to 5.4 cm AAA every three months; a 5.5 cm or larger AAA is referred to a vascular surgeon. Your vascular team may explain a different plan for your circumstances. Keep appointments and ask how to rearrange a missed scan.

Surveillance checks for change; it does not guarantee the aneurysm cannot rupture between scans. New pain needs assessment rather than waiting for the next appointment. Ask for your latest diameter, the measurement method, when the next scan is due and what growth or symptoms would prompt a review.

NICE recommends offering smoking-cessation support to people with AAA who smoke and treating high blood pressure. Management of cholesterol, diabetes and other cardiovascular risks is tailored to the person. These steps support vascular health but do not replace scans or reliably eliminate the risk of rupture. Do not start or stop a medicine or supplement to shrink an aneurysm without discussing it with your clinician.

NICE recommends considering repair for an unruptured AAA if it causes symptoms; if it is asymptomatic, larger than 4.0 cm and has grown by more than 1 cm in a year; or if it is asymptomatic and 5.5 cm or larger. The growth and size criteria use the maximum anterior-posterior inner-to-inner ultrasound measurement. A threshold is a point for assessment and shared discussion, not an automatic instruction to operate.

A team weighs the risk of rupture against the immediate and later risks of repair or continued monitoring. The shape and location of the aneurysm, growth, age, other conditions, fitness, life expectancy and the person’s priorities all matter. In some people the risk of repair outweighs its potential benefit, even if the aneurysm has reached a size at which repair is considered.

Conservative management may mean planned imaging, cardiovascular risk management and a clear route back to the vascular service. When an operation is unlikely to help or is not wanted, ask what monitoring or symptom support is appropriate, how the decision can be revisited and what to do if symptoms change. A decision not to operate now can be reassessed.

A ruptured AAA is an emergency because internal bleeding can cause collapse and death. The ambulance and hospital teams assess breathing and circulation, arrange imaging when appropriate, and contact a regional vascular service urgently. Decisions about transfer and repair are made rapidly; emergency treatment and its risks differ substantially from a planned operation.

For a ruptured aneurysm below the kidney arteries, NICE says either EVAR or open surgery may be considered. The suitable approach depends on anatomy, the person’s condition, staff and facilities. If standard EVAR is unsuitable, open repair can be considered. An emergency choice cannot simply be inferred from the usual elective recommendation, and there may be limited time for detailed discussion.

Where repair is not appropriate or possible, the team should explain the situation and provide compassionate care, including relief of pain and distress. If the person can participate, their wishes should inform decisions; families and carers should be included as circumstances and consent allow.

Open repair replaces the diseased section with a synthetic graft through a large abdominal incision. EVAR places a fabric-covered metal stent graft inside the aorta through arteries, usually from the groins. EVAR generally means a shorter initial stay and recovery; it also requires continuing imaging because the graft can leak or move. Open repair is more invasive upfront but usually needs fewer later aneurysm-related interventions.

NICE recommends offering open repair to people with an unruptured AAA who meet its criteria, unless abdominal conditions, anaesthetic risks or other medical conditions make it unsuitable. It recommends considering EVAR for specified abdominal conditions or other individual considerations, and EVAR or conservative management when anaesthetic risks or medical conditions rule out open surgery. The conversation still needs to cover reasonable options and the person’s preferences.

EVAR depends on a suitable route into the arteries and enough healthy artery for the graft to seal. Aneurysms near branches to the kidneys or bowel can need a specially designed fenestrated or branched graft that preserves flow to those organs. Complex EVAR has added uncertainty and NICE specifies special consent, audit and research arrangements for selected elective cases. Ask which options fit your scan and why.

Compare the likely benefit, risk of death and complications, hospital stay, recovery, possibility of further procedures and follow-up scans over both the short and long term. Ask for numbers that apply as closely as possible to your health and anatomy, what is uncertain, and what happens if you choose monitoring instead. Consider bringing a family member or trusted person to the discussion.

The UK EVAR-1 randomised trial compared elective EVAR with open repair in 1,252 adults aged 60 or older with AAA at least 5.5 cm who were suitable for both procedures; about 90% were men. Thirty-day operative mortality was 1.8% after EVAR and 4.3% after open repair. These were group results in a selected population, not an individual prediction.

In EVAR-1, the early advantage did not persist indefinitely: graft-related complications and reinterventions were more frequent after EVAR, and later follow-up showed higher aneurysm-related mortality after EVAR. Devices and practice have changed since enrolment, and women were underrepresented. The findings inform a conversation about durability, not an exact forecast for a modern device or for someone unsuitable for either trial treatment.

The IMPROVE trial studied a different emergency question: 613 adults with clinically suspected rupture were randomised to an endovascular strategy or open repair. The strategy used EVAR where anatomy allowed and open repair when it did not. Mortality was similar at 90 days; at three years it was 48% versus 56%, respectively. At seven years mortality was about 60% in both groups and a lasting difference remained uncertain.

IMPROVE included people with suspected rupture, not only those ultimately confirmed and repaired; most participants were men, and 502 underwent emergency repair for rupture. It compared strategies, not two procedures received by identical patients. Its emergency results should not be applied as elective surgery probabilities. Neither trial can tell a particular person which choice will work for them.

A pre-operative assessment reviews health, heart and lung function, kidney function, medicines, allergies and previous anaesthetics. Blood tests and other investigations may be needed; NICE says exercise testing may be considered if it will help a shared decision. Tell the team about prescriptions, blood thinners, diabetes medicines, over-the-counter drugs, vitamins and herbal products.

Ask exactly which medicines to continue, pause and restart, and follow the hospital’s instructions on eating and drinking. Do not stop anticoagulants, antiplatelets or other prescribed drugs independently. Tell the team if you become unwell before admission. If you smoke, ask about support to stop; discuss suitable activity, blood pressure and other health conditions with the team.

Plan transport home, time away from work and practical help with shopping, meals and caring responsibilities. Ask about the expected stay, possible critical-care bed, pain relief, wound care and the contact number for problems while waiting. Bring questions about the procedure, alternatives and consent, including any preferences about blood transfusion.

Open repair is major surgery under general anaesthetic. A surgeon makes a large abdominal incision to reach the aneurysm. Blood flow is temporarily controlled, the affected section is opened and a synthetic tube graft is sewn into healthy aorta, sometimes extending into the arteries to the legs. Blood then flows through the graft. The exact incision and graft depend on the anatomy.

After surgery, planned care in critical care or a high-dependency area allows close monitoring. A bladder catheter, drips and sometimes a tube through the nose into the stomach may be used. An epidural or other pain relief can help you breathe, cough and move; the team adjusts the plan to your needs. Eating may restart gradually as the bowel recovers.

For EVAR a vascular specialist accesses an artery, usually through small groin cuts or punctures, and guides a catheter to the aneurysm using X-rays and contrast dye. A compressed fabric-covered stent graft is positioned and opened inside the aorta. Its ends seal against the artery so blood passes through the graft rather than directly pressing on the aneurysm sac. The access sites are then closed.

EVAR may use general, regional or local anaesthesia depending on the person and procedure. Complex grafts can have openings or branches for organ arteries and may involve additional access sites and monitoring. Ask what device is planned, whether conversion to open surgery might become necessary and what the team will do if the graft does not seal as expected.

Both procedures carry risks from surgery and anaesthesia, including bleeding, infection, heart or lung complications, kidney injury, blood clots and death. Blood flow to the bowel or legs can be affected and may require further treatment. The likelihood depends on the person, anatomy and whether repair is planned or an emergency. Ask the team for your own risk estimate and how it was assessed.

Open repair can cause wound problems or a later incisional hernia. Bowel blood-supply problems may rarely require bowel surgery or a stoma. Some people experience changes in sexual function after aneurysm surgery. Raise concerns about fertility, erections or other sexual effects before and after treatment so the team can discuss the possibilities relevant to you.

EVAR can cause bruising, bleeding or infection at an access site, injury to an artery, loss of blood flow to a leg, or kidney injury related to contrast or blocked kidney arteries. The graft can move or blood can leak into the aneurysm sac around or through it, called an endoleak. Some findings need another procedure; some are monitored. A scan determines the finding and the appropriate response.

After open repair, Gloucestershire Hospitals describes a stay commonly around 5 to 10 days and recovery that may take several months. Movement, breathing and leg exercises help recovery; pain relief and gradual return to eating are adjusted to how you are doing. Complications, emergency surgery and other conditions can lengthen the stay and change the plan.

After standard EVAR, some people go home after an overnight stay if checks and mobility allow. Guy’s and St Thomas’ describes full recovery as often taking 3 to 6 weeks, though tiredness can last many weeks and complex repairs may require more monitoring. These are examples from one service, not promises of a particular discharge or recovery date.

Before leaving, ask about wound dressings, stitches, medicines, pain relief, follow-up and a number to call. Gradually build up walking as advised and ask for individual guidance on lifting, exercise, sex and work. Restrictions differ between procedures and between people. Do not assume the timetable for a standard EVAR applies to open or emergency surgery.

Contact your vascular team or seek urgent advice if a wound becomes increasingly red, painful, swollen or starts discharging, or if you feel feverish or unwell. A suddenly painful, pale or cold leg or foot, severe new tummy or back pain, collapse or difficulty breathing needs emergency assessment: call 999. Carry your discharge contact details and explain that you have had AAA repair.

After EVAR, imaging is a long-term part of treatment. Scans check the aneurysm sac, position of the graft and whether blood is leaking around or through it. NICE recommends enrolling people in a risk-based surveillance imaging programme and using CT angiography if an endoleak is suspected; a negative colour duplex ultrasound alone does not rule out an endoleak.

An endoleak means blood is still reaching the sac outside the graft. Some leaks can be observed and some need a further procedure; the type, scan findings and whether the sac is growing affect the decision. Ask which imaging tests you need, when and where they will happen, who will contact you with the result, and how to rearrange an appointment.

Open repair generally does not have the same routine imaging programme as EVAR, but you still need the follow-up your team recommends and assessment of any new symptoms. Keep a record of your repair and the hospital that performed it. Continue prescribed treatment for blood pressure, cholesterol or other cardiovascular conditions as agreed with your clinicians; ask before changing medicines.

In Great Britain, car and motorcycle licence holders must tell DVLA if their aortic aneurysm is 6 cm or more in diameter despite treatment, and must not drive if it is 6.5 cm or more. Bus, coach and lorry licence holders must tell DVLA about an aortic aneurysm of any size and must not drive if it is 5.5 cm or more. Ask your doctor or consultant if you are unsure how the rules apply.

Aneurysm licensing rules are separate from whether you are fit to drive after an operation. Ask your surgeon when you can safely resume, including whether pain, medicines or wound healing limit an emergency stop, and check insurance cover. Northern Ireland has separate DVA licensing arrangements; check current requirements with the DVA and your clinical team rather than assuming the Great Britain DVLA rules apply unchanged.