AORTA
Aneurysm
The aorta is the body's largest artery. It carries blood from your heart, down through your chest and abdomen, then splits low down into two branches (the iliac arteries) that supply each leg.
Abdominal aortic aneurysm
An abdominal aortic aneurysm (AAA) is a weak, bulging section of the aorta in your abdomen – a little like a balloon. A normal aorta is about 20 mm wide; it is called an aneurysm once it reaches 30 mm (3 cm) or more.
Small aneurysms are usually safe to watch. The larger one grows, the higher the chance it will burst (rupture) and cause dangerous internal bleeding. That is why repair is usually advised once it reaches about 55 mm in men or 50 mm in women, or if it grows quickly or causes symptoms.
An aneurysm can also shed small clots that block arteries further down, causing pain or, rarely, loss of a limb.
The good news: when an AAA is found early, it can usually be treated successfully, well before it becomes dangerous.
Symptoms
Most aneurysms cause no symptoms. When they do, you may notice:
A pulsing feeling in your abdomen, like a heartbeat near your belly button
Sudden, severe pain in your abdomen or lower back – this can mean the aneurysm is about to burst
If an aneurysm bursts you may feel sudden intense pain, weakness or dizziness, and may collapse. This is a life-threatening emergency – get medical help immediately.
Causes
The exact cause isn't fully understood. The aorta wall seems to weaken through inflammation, often linked to atherosclerosis (hardening of the arteries). Things that raise your risk include:
Age over 60
A close relative who has had an AAA
High blood pressure
Smoking
Being male – AAA is more common in men
Tests
An aneurysm can sometimes be felt during an examination, but is most often found by chance on a scan done for another reason. To find or measure an AAA, I may arrange:
Abdominal ultrasound
CT scan
MRI
Because an AAA usually causes no symptoms, a one-time ultrasound screening is recommended for men and women aged 65 to 75 who have ever smoked.
Treatment Options
Watchful Waiting
If your aneurysm is too small to need repair, we simply keep an eye on it ("watchful waiting") with regular ultrasound or CT scans. How often depends on its size:
3.0 to 3.9 cm: every few years
4.0 to 4.9 cm: about once a year
5.0 to 5.4 cm: every three to six months
Stopping smoking is the single most important thing you can do to slow its growth. I may also prescribe medication to control your blood pressure and cholesterol.
Surgical Repair
Repair is advised if the aneurysm causes symptoms, is larger than 55 mm in men (50 mm in women), or is growing quickly. In an open repair, I make an incision in your abdomen and replace the weakened section of aorta with a fabric tube (a graft) that takes over the job of the artery. Expect about 5 to 7 days in hospital and 2 to 3 months to recover fully. It is a well-established operation with good long-term durability.
Endovascular Repair
A less invasive option is endovascular repair (EVAR). Instead of opening the abdomen, I make small cuts in the groin and thread a fabric-and-metal tube (a stent graft) up through the blood vessels, using x-ray guidance, to line the aneurysm from the inside. Recovery is quicker – usually only 2 to 3 days in hospital. The trade-offs are that EVAR needs lifelong follow-up scans, and not everyone's anatomy is suitable, so open repair is sometimes the better choice.
References
European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg, 2024.
Society for Vascular Surgery (SVS) Practice Guidelines on the Care of Patients with an Abdominal Aortic Aneurysm. J Vasc Surg, 2018.
US Preventive Services Task Force. Abdominal Aortic Aneurysm: Screening.
Open Surgical Repair
Endovascular Repair
Our Services
Arterial
Procedures
Standard open arterial surgical procedures to repair aorta aneurysm and / or reconstruct blood flow to the lower extremities.
Open aorta aneurysm repair
Aorta-bifemoral bypass
Iliofemoral bypass
Endovascular
Procedures
Less invasive percutaneous procedures to repair blood flow through the aorta to intestines, organs and extremities.
Mesenteric artery angioplasty
Renal artery angioplasty
Aorta angioplasty
Iliac artery angioplasty
Subclavian artery angioplasty
Hybrid
Procedures
Combined endovascular and open surgical procedures to repair abdominal aorta aneurysms, thoracic aneurysm or to improve blood flow to the extremities.
Endovascular abdominal aorta aneurysm repair
Endovascular thoracic aorta aneurysm repair
If you have any problems with any of these conditions, please contact your General Practitioner, or your Vascular Surgeon. If you live in Pretoria and have not seen a Vascular Surgeon before, you are more than welcome to contact my rooms for a formal consultation.
Gregory Weir Vascular Surgery
The purpose of this web site is to offer Dr Weir’s patients and their families access to information regarding vascular disease in general as well as specific information on certain disease processes. The information on this site does not necessarily apply to all patients with the same diagnosis. If you are not a patient of Dr Weir, please do not regard the information on this website as a substitute for a thorough assessment by a qualified Vascular Surgeon. If in doubt, consult your doctor.
If you are experiencing a medical emergency, phone us. If you are not able to get through or if we are not available, please visit your nearest casualty department.
Consultation Rooms
Vascular & Hyperbaric Unit, Life Eugene Marais Hospital, Pretoria
Medically reviewed by Dr Gregory Weir, vascular surgeon. Last updated June 2026.