Some people describe it as a ticking timebomb. Others learn to live with information they can neither see nor feel, but cannot forget. This is what it can mean to be diagnosed with an abdominal aortic aneurysm: a swelling in the body’s main artery that becomes more likely to rupture as it grows, despite causing no symptoms.

For most people with a small aneurysm, surgery is not the safest option. Regular scans are used to track its growth. This avoids an operation they may not need, but can leave them living with uncertainty for years.

An abdominal aortic aneurysm, or AAA, develops in the section of the aorta that runs through the abdomen. Most cause no noticeable symptoms. In England, men are invited for a screening ultrasound in the year they turn 65. Aneurysms can also be found during tests for another condition.

The risk depends partly on the aneurysm’s size and growth rate. Smaller AAAs are usually managed through active surveillance, alongside measures to reduce cardiovascular risk. A review of four clinical trials found no survival advantage to operating early on small, symptom-free aneurysms. Repair itself carries risks including heart attack, stroke and kidney damage.

Our research suggests that the emotional effect of surveillance can be underestimated.

Living between normality and danger

We reviewed 14 studies involving 150 people with AAA. Most were men; participants were aged from 53 to 88. The studies explored their experiences of diagnosis, surveillance, surgery and recovery.

They provide detailed accounts of what people went through, although........

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