The Silent Threat: Why Older Male Smokers Need Abdominal Aortic Aneurysm Screening

Persistent pain in the abdomen, lower back, or flank—or an uncomfortable sensation of fullness—should never be brushed off as routine indigestion or a passing flu. In some cases, these warning signs signal a hidden danger: an enlarging abdominal aortic aneurysm (AAA).

An abdominal aortic aneurysm occurs when the aorta—the body’s largest blood vessel, which delivers oxygen-rich blood from the heart to the rest of the body—bulges abnormally. As the aortic wall thins and balloons outward, it struggles to withstand internal blood pressure, eventually risking a catastrophic rupture.

"When an abdominal aortic aneurysm ruptures, it causes massive internal bleeding. It is so dangerous that more than half of patients die before they even reach the hospital," said Cho Jin-hyun, a professor of vascular surgery at Kyung Hee University Hospital at Gangdong. "However, if an aneurysm is detected early, regular monitoring and proper risk-factor management can save lives."

The condition is becoming increasingly prevalent. According to data from the Health Insurance Review & Assessment Service, the number of patients treated for abdominal aortic aneurysms in South Korea climbed sharply from 10,630 in 2020 to 15,650 in 2025.

Because these aneurysms rarely cause clear symptoms before a rupture, they are notoriously difficult to detect. Many cases are discovered completely by accident during routine health checkups or imaging tests for unrelated conditions.

"If someone falls into a high-risk group, they should strongly consider early screening, such as an abdominal ultrasound or CT scan, to evaluate the size and shape of the blood vessel," Cho stressed.

The primary high-risk demographic includes men aged 65 and older with a history of smoking. However, individuals with underlying health conditions like hypertension, hyperlipidemia (high cholesterol), or atherosclerosis, as well as those with a family history of the disease, are also strongly advised to undergo proactive screening before any symptoms appear.

If an aneurysm is detected, treatment options—such as traditional open surgery or minimally invasive stent placement—are determined by the diameter of the aorta and its rate of expansion. Recently, hybrid treatments combining the benefits of both open surgery and stent therapy have gained traction.

"This approach maximizes treatment effectiveness while minimizing surgical trauma," Cho explained. "It can be applied selectively based on the patient's unique vascular anatomy and overall health."

Post-treatment care requires rigorous lifestyle modifications to prevent recurrence, with smoking cessation topping the list.

"Smoking weakens the blood vessel walls and triggers chronic inflammation, making quitting absolutely non-negotiable," Cho advised. "In tandem, patients must strictly manage their blood pressure and cholesterol levels while incorporating regular exercise into their daily routines."