Most health conditions give you some warning. A sore knee, a cough that lingers, a rash that will not settle. An abdominal aortic aneurysm does almost nothing at all, right up until the day it does everything. It is silent, it is more common than people realise in men over 65, and in Ireland there is no national programme quietly checking for it the way there is for breast, bowel and cervical cancer. That is exactly why it is worth knowing about.
TL;DR
- An abdominal aortic aneurysm (AAA) is a bulge in the main artery running through the abdomen, diagnosed when the aorta reaches 3cm or more against a normal width of around 2cm.
- The biggest risk factors are being male, being over 65, and smoking. A father or brother with an AAA also raises your risk significantly.
- Most aneurysms cause no symptoms at all. If one ruptures, roughly eight in ten people do not survive, which is why finding them early matters so much.
- The UK offers every man a one-off ultrasound at 65. Ireland has no equivalent national screening programme, so detection here depends largely on your GP and on scans done for other reasons.
- Stopping smoking is by far the single most effective thing you can do. The HSE Quitline is 1800 201 203.
What an aortic aneurysm actually is
The aorta is the body’s main artery, carrying blood from the heart down through the chest and abdomen before dividing to supply each leg. In the abdomen it is normally about two centimetres across, roughly the width of a garden hose.
With age, and particularly with smoking and high blood pressure, the wall can weaken and stretch. At three centimetres or more it is classed as an aneurysm. Most stay small and grow very slowly, often by a couple of millimetres a year. The concern is that as the diameter increases, the wall thins and the risk of rupture climbs steeply.
A rupture is a catastrophic internal bleed, and counting those who never reach hospital, roughly 80 per cent are fatal. Planned repair of an aneurysm found in advance is a different story entirely, and the difference between those two outcomes is simply whether anyone knew it was there.
Who is most at risk
- Sex. Men are around six times more likely to develop an AAA than women. When women do develop one, though, it tends to rupture at a smaller size, so this is not a male-only concern.
- Age. Risk rises sharply from the mid-60s onward.
- Smoking. The strongest modifiable factor by a distance. Current and former smokers make up the large majority of cases, and smoking both raises the chance of an aneurysm forming and speeds up how fast it grows.
- Family history. A parent or sibling who had an AAA meaningfully increases your own risk. Worth raising with your GP by name.
- Blood pressure and existing artery disease. If you have been treated for angina, peripheral artery disease or a stroke, the same process affects the aorta.
The Irish screening gap
In the United Kingdom, every man is invited for a single abdominal ultrasound in the year he turns 65. It takes about ten minutes, involves no radiation and no needles, and has been shown to reduce deaths from ruptured aneurysms.
Ireland does not currently operate a national AAA screening programme. Our population programmes cover BreastCheck, CervicalCheck, BowelScreen and Diabetic RetinaScreen, and proposals for new ones go through the National Screening Advisory Committee, which invites submissions from clinicians and the public. AAA screening has been raised as a candidate, but there is no invitation scheme in place here.
In practice, aneurysms are found in Ireland one of three ways: incidentally on a CT or ultrasound done for something else, by a GP who feels a pulsatile swelling during an abdominal examination, or because someone with clear risk factors asked. That last route is the one within your control. If you are a man over 65 who has ever smoked, or a close relative had an aneurysm, it is entirely reasonable to raise it at your next GP appointment and ask whether an abdominal ultrasound would be appropriate.
If an aneurysm is found
Finding one is not an emergency. Small aneurysms are monitored rather than operated on, because the risk of surgery outweighs the risk of a small bulge. Surveillance typically follows the size: yearly ultrasound between 3.0 and 4.4cm, roughly every three months between 4.5 and 5.4cm, and referral to a vascular surgery team at 5.5cm or above. Growth of more than a centimetre in a year, or any symptoms, brings that referral forward.
Repair takes one of two forms. Open surgery replaces the weakened section with a synthetic graft: longer recovery, durable result. Endovascular repair (EVAR) threads a stent graft up through the arteries in the groin, meaning a much shorter hospital stay but lifelong follow-up imaging. Which suits you depends on the shape of the aneurysm, your fitness and your own preferences.
Vascular surgery here is concentrated in regional specialist units, and waiting times for elective assessment vary. If a wait is long, ask your GP about the National Treatment Purchase Fund, and use the time for prehabilitation: stopping smoking, controlling blood pressure and building fitness all improve surgical outcomes.
The symptoms that mean call 112 or 999
Some people notice a pulsing sensation in the abdomen, a bit like a heartbeat in the belly, or a persistent dull ache in the lower back or side. A rupture is different and unmistakeable:
- Sudden, severe pain in the abdomen or lower back, often described as tearing.
- Pain spreading towards the groin or legs.
- Feeling faint, clammy, breathless, or losing consciousness.
- Pale, sweaty skin and a rapid heartbeat.
This is a call-an-ambulance situation, not a wait-and-see one. Ring 112 or 999 immediately and say you are concerned about an aortic aneurysm, because it changes how the call is prioritised and where you are brought.
What genuinely reduces your risk
No tablet has been convincingly shown to shrink an aneurysm or reliably slow its growth. What helps is unglamorous and effective.
Stop smoking. Nothing else comes close. It reduces the chance of an aneurysm forming, slows the growth of one you already have, and lowers rupture risk. The HSE Quitline on 1800 201 203 offers free support and free nicotine replacement therapy, and it works far better than going it alone, at any age.
Control your blood pressure. Get it checked, and if you are on treatment, take it consistently. If you hold a medical card or GP visit card and have a qualifying condition such as hypertension, the HSE Chronic Disease Management Programme provides structured GP reviews at no cost.
Keep moving. A common worry is that exercise might burst an aneurysm. Moderate activity such as walking, cycling and swimming is considered safe. If you have a known aneurysm, ask your vascular team about heavy lifting specifically rather than avoiding activity altogether.
Mind your cholesterol. Statins do not shrink aneurysms, but people with an AAA are at high risk of heart attack and stroke from the same underlying artery disease.
Where to turn
Your GP is the starting point, including for the conversation about whether a scan makes sense for you. The Irish Heart Foundation and Croí both offer plain-language cardiovascular information and support.
At Crionna Health we write about what gets overlooked in later life, and this is overlooked more than most. If you are a man in your late 60s who used to smoke, that conversation is worth having sooner rather than later.
This article is for general information and is not a substitute for individual medical advice. Always discuss your own circumstances with your GP or healthcare team.
📷 Photo by Fenghua on Unsplash
