An aneurysm is when a weakened wall of an artery balloons out. There are virtually no symptoms until it ruptures, when the patient bleeds to death internally (the aorta is the body’s largest artery). Abdominal aortic aneurysms (AAA) are caused mainly by smoking, also high blood pressure, & genetics (especially if a brother or sister had one).
The main symptom of a ruptured AAA is sudden onset of terrible abdominal pain. It usually starts with just a leak, then bleeds more & more. Diagnosis is easily made by an ultrasound or CT scan; those tests can’t see the bleeding, but the aneurysm is obvious. Large-enough aneurysm plus sudden abdominal pain equals rupture.
There are many signs we can read about in textbooks, like feeling a mass in the abdomen, not being able to feel the femoral pulse in the groin, and more. These are all unreliable. Some patients get misdiagnosed as a kidney stone because there happens to be unrelated blood in a urinalysis. The key to diagnosis is thinking of it: any patient over age 60 with sudden onset of severe abdominal pain, especially if they have risk factors, deserves a CT scan, most conveniently done in an ER.
Immediate surgery only saves 50% of patients. However, surgery on a large AAA before rupture is very successful. Anybody who has ever smoked up to 30 packs of cigarettes in their life (just 600 cigarettes total) should have an ultrasound when they’re 65-years-old. If there’s an aneurysm, the test should be repeated every 6 – 12 months to check size. Surgery is done when it’s bigger than 5.5 cm.