Aorta · abdomen
Abdominal aortic aneurysm
An AAA forms in the aorta below the chest, often below the kidney arteries. Ultrasound can screen and monitor many AAAs; CTA maps anatomy when repair is considered.
Aneurysm evaluation · Los Angeles
Aortic & peripheral artery aneurysms need a plan before symptoms.
An aneurysm is a weakened artery wall that has enlarged. It may grow without warning signs. EVSLA reviews the location, diameter, shape, growth, anatomy, and whole-patient risk to explain whether surveillance, endovascular repair, open surgery, or specialty referral makes sense.
- Imaging-led planning
- Endovascular expertise
- Coordinated surgical referral
A finding worth reviewing
Was an aneurysm found on a scan?
- Ask where it is and its maximum diameter
- Compare earlier imaging to measure growth
- Sudden severe pain or fainting is an emergency
Aneurysm care is not based on diameter alone.
Location, symptoms, growth, anatomy, and overall health change the plan.
What is an aortic or peripheral artery aneurysm?
An aneurysm is an abnormal enlargement of an artery caused by weakening of the vessel wall. The aorta is the body’s largest artery; aneurysms can also form in iliac arteries in the pelvis or peripheral arteries such as the popliteal artery behind the knee.
Many aneurysms cause no symptoms and are discovered on imaging. The important questions are where the aneurysm is, how large it is, whether it is growing or causing symptoms, and whether its anatomy makes surveillance, endovascular repair, open repair, or multidisciplinary referral the safest path.
Sources: Society for Vascular Surgery — Abdominal Aortic Aneurysms and 2022 ACC/AHA Aortic Disease Guideline
Location changes the problem
Four aneurysm patterns—and four different pathways
“Aneurysm” describes the vessel-wall problem, not a single treatment. The artery involved determines the imaging, rupture or clotting risk, repair options, and specialist team.
Pelvis
Iliac artery aneurysm
An aneurysm in a pelvic artery may occur alone or with an AAA. Branch anatomy matters when planning an endovascular graft or open repair.
Behind the knee
Popliteal artery aneurysm
This peripheral aneurysm can form clot, send debris to the foot, or suddenly block leg blood flow. Duplex ultrasound is central to evaluation and follow-up.
Aorta · chest
Thoracic aortic aneurysm
Aneurysms in the chest, aortic root, or ascending aorta require location-specific cardiovascular or cardiothoracic expertise and a multidisciplinary aortic team.
Aorta and pelvis
Peripheral and thoracic pathways
An aneurysm is not the same as an aortic dissection. An aneurysm is enlargement of the vessel; a dissection is a tear within the aortic wall. Both can become emergencies, but the workup and treatment are not interchangeable.
(ACC/AHA Guideline)Possible warning signs
Most aneurysms are silent—symptoms depend on location
These symptoms can have many causes and do not diagnose an aneurysm. A known aneurysm with new pain deserves prompt medical advice; sudden severe symptoms need emergency care.
Do not press repeatedly on a suspected pulsatile mass. A clinician should determine whether the finding is vascular and select the appropriate imaging.
Emergency symptoms
A rupture or sudden loss of limb flow cannot wait.
An aneurysm may rupture, tear, clot, or send embolic debris downstream. Those complications can become life- or limb-threatening within minutes.
Sources: SVS — Patients with AAA and SVS Popliteal Aneurysm Guideline .
Risk and screening
Smoking history is a major clue—but not the only one.
AAA risk rises with age, tobacco exposure, family history, high blood pressure, atherosclerotic disease, and aneurysm in another artery. A person with one aneurysm may be evaluated for aneurysms elsewhere.
Risk factors to discuss
- Current or previous cigarette smoking
- Age, male sex, and cardiovascular risk
- First-degree relative with an aortic aneurysm
- Known iliac, femoral, or popliteal aneurysm
- Genetic or connective-tissue aortopathy
Screening guidance applies to people without symptoms. New pain or emergency symptoms need diagnostic evaluation, not routine screening. Source: USPSTF — Abdominal Aortic Aneurysm Screening .
Diagnosis and surveillance
Measure the aneurysm consistently—and compare it over time
One scan gives a diameter. The care plan also needs location, morphology, branch-vessel anatomy, symptoms, prior measurements, and the clinical context.
- Ultrasound for AAA screening and many surveillance visits
- Duplex ultrasound for popliteal and other accessible peripheral aneurysms
- CTA or MRA when detailed anatomy or repair planning is needed
- Consistent measurement technique and review of prior imaging
Five questions guide the workup
1 · Where
Which artery and segment are involved?
Abdominal, iliac, popliteal, thoracic, root, and ascending aneurysms have different pathways.
2 · Size
What is the maximum diameter?
Measurement must be interpreted using location, sex, body size, and morphology.
3 · Growth
Has it changed since the last scan?
Prior images and reports help distinguish stable disease from concerning growth.
4 · Effect
Is it painful, compressing, clotting, or embolizing?
Symptoms can change timing even when a diameter is below a typical elective threshold.
5 · Anatomy
Can a repair seal safely and preserve branches?
Access arteries, landing zones, kidney vessels, pelvic branches, and runoff all matter.
The ACC/AHA guideline emphasizes consistent imaging acquisition, measurement, and reporting. Read the guideline summary..
Treatment decision
Choose the safest path—not simply the biggest procedure
Repair is recommended when the predicted risk of rupture, thrombosis, embolization, or other complication outweighs procedural risk. The balance is individualized.
Monitor
Surveillance and risk reduction
Smaller, stable, asymptomatic aneurysms are often followed with scheduled imaging while cardiovascular risks are addressed.
- Defined imaging interval
- Smoking cessation
- Blood-pressure and cardiovascular care
- Clear emergency instructions
Repair from within
Endovascular aneurysm repair
EVAR or a covered stent-graft may exclude selected aneurysms from circulation through catheter-based access.
- Anatomy must provide safe seal zones
- Branch vessels may require special planning
- Kidney function and access arteries matter
- Lifelong imaging surveillance is required
Reconstruct
Open or multidisciplinary repair
Open surgery may offer the better durable option for some patients or anatomies. Root and ascending aortic disease usually requires a cardiothoracic pathway.
- Open graft replacement or bypass
- Cardiothoracic or aortic-team referral
- Hybrid or branched strategies when appropriate
- Shared decision-making
Endovascular repair
How EVAR excludes an abdominal aortic aneurysm
EVAR places a stent-graft inside the artery so blood travels through the graft instead of pressurizing the aneurysm sac. It is less invasive than open abdominal repair, but it is not minor and it is not appropriate for every anatomy.
- CTA-based planning
- Image-guided access
- Patient-specific graft sizing
- Seal-zone assessment
- Branch preservation planning
- Lifelong surveillance
Plan the repair
CTA measurements define the aneurysm, access arteries, seal zones, angulation, kidney arteries, and pelvic branches.
Reach the aorta
Catheters and the graft system are advanced through access arteries, commonly from the groin, under live X-ray guidance.
Deploy and seal
The stent-graft is positioned to channel blood past the aneurysm while preserving critical branches whenever possible.
Monitor for life
Follow-up imaging checks graft position, aneurysm-sac size, blood flow, and endoleak. Surveillance remains necessary even when recovery is smooth.
Endovascular popliteal or iliac aneurysm repair uses different devices and anatomic criteria. Some patients are better served by open bypass or reconstruction. The repair must match the artery, the downstream circulation, and the patient’s expected durability needs.
Repair candidacy
When an endovascular option belongs in the conversation
Aneurysm size is important, but candidacy is a balance of complication risk, anatomy, procedural risk, life expectancy, and patient goals.
The decision considers…
- Location, maximum diameter, shape, symptoms, and growth
- Healthy landing zones and branch-vessel anatomy
- Access-vessel size, calcification, and tortuosity
- Heart, lung, kidney, mobility, frailty, and surgical risk
- Open, endovascular, hybrid, surveillance, and referral alternatives
- Ability to complete lifelong follow-up imaging
What happens
From incidental finding to a defined plan
Bring the actual imaging disc or portal access when possible—not only the report. Earlier studies are especially valuable for measuring growth.
- Triage symptoms The team first rules out pain or circulation changes that require emergency or hospital-level care.
- Review the scan The artery, segment, maximum diameter, morphology, thrombus, branch vessels, and access anatomy are identified.
- Compare prior imaging Growth rate is assessed using the most consistent available measurements and source images.
- Estimate whole-patient risk Smoking, family history, cardiovascular disease, kidney function, prior surgery, frailty, and goals are considered.
- Discuss every reasonable path Surveillance, EVAR, covered stent, open surgery, hybrid repair, or specialty referral is compared honestly.
- Set follow-up before you leave The plan includes imaging timing, risk-factor care, warning signs, and who owns each next step.
Your care team
Who evaluates aneurysm anatomy at EVSLA
Aneurysm care often crosses specialties. EVSLA can evaluate the vascular and endovascular component and coordinate referral when open vascular, cardiothoracic, genetic-aortopathy, or hospital-based care is the safer pathway. Physician credentials and exact aneurysm services must be confirmed before publication.
Harout Dermendjian, MD
Endovascular Specialist
Featured in this concept for image-guided vascular evaluation and endovascular planning. Confirm approved AAA, EVAR, iliac, and peripheral aneurysm service language before publication.
Kartik Kansagra, MD
Endovascular Specialist
Featured in this concept for arterial imaging review, endovascular candidacy, and coordination with vascular or cardiothoracic surgery. Confirm the actual pathway before publication.
Sipan Mathevosian, MD
Endovascular Specialist
Featured in this concept for vascular and interventional radiology care. Confirm training, specialty description, repair capability, and hospital relationships against approved content.
Where to request an aneurysm evaluation
Three clinics across Los Angeles County
Call before traveling so the team can review the referral, identify any emergency concern, and confirm the correct clinic or hospital pathway. Verify imaging access, EVAR capability, surgical partnerships, and scheduling at each location before publication.
Glendale
445 W Broadway
Glendale, CA 91204
Simi Valley
2750 Sycamore Dr, Ste 200
Simi Valley, CA 93065
La Cañada Flintridge
1407 Foothill Blvd
La Cañada, CA 91011
Questions patients ask
Aortic and peripheral aneurysms, answered plainly
What is the difference between an aneurysm and a dissection?
An aneurysm is abnormal enlargement caused by weakening of an artery wall. An aortic dissection is a tear in the inner aortic wall that allows blood to separate layers of the vessel.
They can occur separately or together, and both can become emergencies. Sudden severe chest, back, or abdominal pain, fainting, or neurologic symptoms requires emergency care.
Can an aortic aneurysm cause no symptoms?
Yes. Many abdominal and thoracic aortic aneurysms are discovered incidentally during imaging for another reason or through screening. Lack of pain does not show whether an aneurysm is stable.
A known aneurysm needs a defined surveillance plan. The interval depends on its location, size, growth, anatomy, and the guideline used by the treating team.
What size abdominal aortic aneurysm needs repair?
There is no single number for every patient. The Society for Vascular Surgery recommends elective repair for many patients at acceptable risk with a typical fusiform AAA at or above 5.5 cm, and suggests repair for women with AAA between 5.0 and 5.4 cm.
Symptoms, saccular shape, concerning growth, body size, anatomy, sex, operative risk, and patient preference can change timing. Do not use a report measurement to make this decision without specialist review.
Who should be screened for an abdominal aortic aneurysm?
The USPSTF recommends one-time ultrasound screening for men age 65 to 75 who have ever smoked and selective screening for men in that age group who have never smoked.
For women, recommendations depend on smoking and family history, and evidence is less certain in some groups. Screening guidance is for people without symptoms; symptoms need diagnostic evaluation.
What is EVAR?
Endovascular aneurysm repair uses a stent-graft delivered through arteries, commonly from the groin, to create a new channel inside the aorta and reduce pressure on the aneurysm wall.
EVAR requires suitable anatomy and careful graft sizing. It usually avoids a large abdominal incision but still carries risks and requires lifelong imaging for endoleak, graft position, and aneurysm-sac change.
Is EVAR better than open aneurysm surgery?
Neither approach is best for everyone. EVAR is less invasive and often has a shorter initial recovery, while open repair may offer the more appropriate or durable solution for certain anatomies and patients.
The choice considers age, overall health, life expectancy, aneurysm anatomy, access vessels, kidney function, prior surgery, ability to complete surveillance, and the patient’s priorities.
Can a peripheral aneurysm threaten the leg?
Yes. A popliteal aneurysm can form clot, suddenly thrombose, or send embolic material into smaller arteries of the foot. Symptoms can include a cold painful foot, blue toes, numbness, weakness, or a non-healing wound.
Sudden symptoms can indicate acute limb ischemia and require emergency assessment. Stable aneurysms still need surveillance or timely repair planning.
How often is an aneurysm scanned?
The interval depends on location, diameter, growth, symptoms, imaging quality, and whether the aneurysm has been repaired. Smaller stable aneurysms are generally scanned less often than larger or changing aneurysms.
After EVAR, imaging begins early and continues long term. Follow the schedule from the treating team rather than applying another person’s interval to your scan.
Can medicine make an aneurysm shrink?
There is no medication that reliably reverses an established degenerative aneurysm. Medical care focuses on smoking cessation, blood-pressure and cardiovascular risk management, and treatment of related disease.
Do not start or stop medication based on general website information. The prescribing clinician should tailor treatment to the patient’s full cardiovascular and medical history.
When should I go to the emergency room for an aneurysm?
Call 911 for sudden severe chest, back, abdominal, flank, groin, or leg pain; fainting; clammy weakness; difficulty breathing; new neurologic symptoms; or a suddenly cold, pale, numb, weak, or immobile limb.
Do not drive yourself. Tell emergency personnel if you have a known aneurysm and where it is located.
Clinical review required before publication
Assign an EVSLA physician reviewer and confirm which aortic, iliac, and peripheral aneurysms the practice evaluates or treats; EVAR and hospital capabilities; open-surgery and cardiothoracic referral pathways; physician credentials; location capabilities; emergency language; and insurance statements. Add reviewed and next-review dates.
An aneurysm found on a scan deserves a defined next step.
Bring the imaging report, source images, and any earlier scans. EVSLA can review the vascular anatomy, explain surveillance and endovascular considerations, and coordinate a surgical or multidisciplinary referral when that is the safer pathway.
Request an Aneurysm Evaluation
Call (818) 626-3710
For sudden severe pain, fainting, or sudden loss of limb circulation, call 911.