A leaking abdominal aortic aneurysm may feel like abdominal pain or tenderness, along with other symptoms. You may recognize these certain symptoms when it’s time to take action.

Abdominal aortic aneurysms (AAAs) are the most common type of aortic aneurysms, which are balloon-like bulges that can develop in your aorta. Aneurysms that form above the diaphragm are called “thoracic aneurysms,” but below the diaphragm they’re considered “abdominal aneurysms.”

Aneurysms often lead to medical emergencies because they can develop slowly over time without particularly noticeable symptoms.

In this article, you’ll learn who’s at risk of an AAA, what symptoms are possible, and what may happen if you develop an abdominal aneurysm that isn’t treated quickly.

In simple terms, an aortic aneurysm forms when the wall of an artery weakens over time and bulges. This bulging can lead to tears, bleeding, or even a complete rupture of the artery.

When these aneurysms develop below the chest, they’re referred to as “abdominal aortic aneurysms.” AAAs are diagnosed in about 200,000 people in the United States each year.

Smaller aneurysms are usually checked for growth over time, and surgery is offered to repair the aneurysm when leaking or rupture is likely. Ruptured AAAs are fatal in 85–90% of cases and are the 15th leading cause of death in the United States.

AAAs can be difficult to diagnose early because they usually develop over time without obvious symptoms.

When symptoms do develop, they can appear with subtle difficulties, including throbbing or pain in your side, legs, buttocks, or groin.

In many cases, severe abdominal pain is the only symptom, and this symptom could be present in all kinds of other conditions.

Other signs to watch for in an AAA that’s leaking, is about to rupture, or has already ruptured, may include:

  • a noticeable throbbing mass in the abdomen
  • abdominal pain or tenderness
  • changes in blood pressure
  • increased heart rate
  • a drop in your blood counts

An AAA may be difficult to quickly diagnose and treat because of the classic symptoms that may not be evident in every person.

It’s possible for these symptoms to appear with a wide range of other concerns, so a healthcare team will use the following information to help make a diagnosis:

  • physical examination
  • blood tests
  • imaging tests such as an ultrasound or CT scan
  • information about your personal and family medical history

If you’re at risk of developing an AAA, or a doctor believes an aortic aneurysm may be the cause of your symptoms, additional imaging tests or scans may be required.

Smaller AAAs — such as those measuring about 5.5 centimeters (cm) and under — may be observed for a while for growth or weakening of the artery walls. Aneurysms are usually repaired with surgery when they measure above 5 cm, or when there’s evidence of leaking, bleeding, and foreseeable rupture.

If your aneurysm hasn’t ruptured, but there’s evidence of bleeding or blood leaking between the vessel walls, this condition is often diagnosed as an aortic dissection and requires immediate medical treatment.

Age and sex play a big role in your chances of developing an AAA. Older men are the most at-risk group, and AAA is the 10th leading cause of death in men who are 55 years and older.

Language matters

You’ll notice that the language used to share stats and other data points is pretty binary, especially with the use of the term “men” in this article.

Although we typically avoid language like this, specificity is key when reporting on research participants and clinical findings.

Unfortunately, the studies and surveys referenced in this article didn’t report data on, or include, participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

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Other health issues and risk factors that may increase your chances of developing an AAA include:

It’s important to follow up with a healthcare team to discuss possible risk factors and address them as needed to slow any aneurysm progression.

Not treating signs and symptoms of a leaking AAA — or a known AAA with no symptoms — can lead to a possibly fatal rupture.

Newer diagnostic tools such as a bedside ultrasound are improving the odds of survival with an AAA, but an older study from 2005 found that 25% of people who experience a ruptured AAA die before reaching a hospital for emergency care.

The 2005 study also found that another 51% of people die at the hospital before surgery can be performed, and about 46% of those people who undergo surgery to repair an AAA die during the repair.

Overall, the 2005 study found that only about 11% of people who experience a ruptured AAA are alive a month after the event. Meanwhile, only about 4–6% of AAAs are fatal in people who have an elective aortic repair before a rupture, when aneurysm size or leaking indicates a developing concern.

A leaking or dissected AAA can develop before a potentially fatal rupture. If you know you have an AAA, and it’s above a designated size, increasing in size, or there are signs that the vessel wall is weakening and leaking or bleeding, medical treatment with elective surgery is important to help you avoid a possibly fatal emergency.

Talk with a healthcare team about your AAA risk, the size of your AAA if you have one, and how often screenings are necessary if your aneurysm isn’t large enough to consider repair.