Abdominal Aortic Aneurysm Treatment by a Cleveland Clinic Vascular Surgeon
Abdominal Aortic Aneurysm: Personalized, Value-Based Care at Cleveland Clinic
Cleveland Clinic in Cleveland, Ohio is a worldwide leader in the treatment of aortic disease, with a legacy that traces back to the pioneering work of Dr. Roy K. Greenberg and the innovation of fenestrated and branched endovascular technology. As vascular surgeons at Cleveland Clinic’s Heart & Vascular Institute, our approach to abdominal aortic aneurysm (AAA) care is grounded in science, experience, and personalization. We recognize that no two patients—and no two aneurysms—are alike.
An abdominal aortic aneurysm is a silent condition in which the main artery in the abdomen slowly enlarges over time. Most patients feel no symptoms until the aneurysm becomes large or ruptures. That is why early diagnosis and careful surveillance are critical. Our focus is on tailoring care to each patient’s individual anatomy, clinical presentation, and medical conditions, including heart disease, lung disease, and kidney disease. Value-based care means intervening only when the benefit clearly outweighs the risk—and never sooner than the science supports.
At Cleveland Clinic, we are deeply committed to evidence-based thresholds for intervention. National guidelines support repair of most abdominal aortic aneurysms in men when the diameter reaches 5.5 centimeters, unless symptoms or rapid growth justify earlier treatment. We have published on the importance of quality programs and dashboards—including work by Smolock, Pickney, and Kirksey—that ensure patients are followed appropriately, aneurysms are measured accurately, and repairs are performed at the right time for the right patient.
When surgery is necessary, the most important decision is choosing the right type of repair. For some patients, minimally invasive endovascular aneurysm repair (EVAR) offers faster recovery and lower short-term risk. For others—especially younger patients or those with complex anatomy—open surgical repair may provide the most durable long-term solution. The goal is not simply to fix an aneurysm, but to select the treatment that best matches the patient’s age, anatomy, overall health, and life expectancy.
This personalized approach is supported by a multidisciplinary team. Our interventional cardiology and cardiology colleagues at Cleveland Clinic play a critical role in preoperative evaluation, optimization, and—when needed—postoperative rescue. This team-based model improves safety, outcomes, and long-term survival, particularly for patients with complex heart or lung disease.
Access and early diagnosis matter. I have published work with Dr. Greg Piazza demonstrating higher mortality from abdominal aortic aneurysm in rural communities, likely related to lower rates of screening and delayed diagnosis. Programs such as “Welcome to Medicare” AAA screening—which offers a one-time ultrasound for eligible patients—are powerful tools to identify aneurysms before they become life-threatening. When AAA is found early, most patients can be safely monitored for years.
A Hopeful Message
Abdominal aortic aneurysm does not have to be a sudden or fatal diagnosis. With early screening, careful observation, evidence-based thresholds, and individualized treatment, outcomes can be excellent. At Cleveland Clinic, our mission is to combine innovation, experience, and compassion to deliver the safest and most effective care—tailored to each patient.
Patient Checklist: Who Is at Risk for Abdominal Aortic Aneurysm (AAA)?
You may be at increased risk for an abdominal aortic aneurysm if any of the following apply:
Major Risk Factors
☐ Male, age 65 or older
☐ Current or former smoker (strongest risk factor)
☐ Family history of AAA (parent, sibling)
☐ High blood pressure
☐ High cholesterol
☐ History of heart disease or vascular disease
☐ Peripheral artery disease or carotid artery disease
Medical Conditions That Increase Risk
☐ Chronic lung disease (COPD/emphysema)
☐ Chronic kidney disease
☐ History of coronary bypass or stents
☐ Long-standing atherosclerosis
Symptoms That Require Immediate Evaluation
(Most AAAs have no symptoms—these are warning signs.)
☐ New or persistent abdominal, back, or flank pain
☐ Pulsating feeling in the abdomen
☐ Sudden severe pain with dizziness or collapse (medical emergency)
Important Screening Message
Men aged 65–75 who have ever smoked should receive a one-time abdominal ultrasound
Medicare covers AAA screening as part of the Welcome to Medicare visit
Early detection saves lives
Smolock CJ, Pickney K, Kirksey L, et al. J Vasc Surg. 2023
El-Arousy H, Lim S, Batagini NC, Lyden SP, Clair DG, Kirksey L. J Vasc Surg. 2019
Chaikof EL, et al. SVS AAA Guidelines. J Vasc Surg. 2018