Abdominal aortic aneurysm

Last reviewed: 21 Apr 2022
Last updated: 19 Oct 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • palpable pulsatile abdominal mass
Full details

Other diagnostic factors

  • abdominal, flank, or back pain
  • hypotension
  • loss of consciousness
  • pallor
  • abdominal distension
  • fever
Full details

Risk factors

  • cigarette smoking
  • hereditary/family history
  • increased age
  • male sex (prevalence)
  • female sex (rupture)
  • congenital/connective tissue disorders
  • hyperlipidaemia
  • COPD
  • atherosclerosis (i.e., coronary artery disease [CAD], peripheral arterial occlusive disease)
  • hypertension
  • increased height
  • central obesity
  • non-diabetic
  • European ethnicity
Full details

Diagnostic investigations

1st investigations to order

  • aortic ultrasound
Full details

Investigations to consider

  • cross match
  • clotting screen
  • erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP)
  • FBC
  • blood cultures
  • computed tomography angiography (CTA)
  • magnetic resonance angiography (MRA)/MRI
  • positron emission tomography-computed tomography (PET-CT)
Full details

Treatment algorithm

ACUTE

ruptured AAA

symptomatic, but not ruptured AAA

ONGOING

incidental finding of asymptomatic AAA: <5.5 cm (but not >4.0 cm and rapidly growing)

incidental finding of asymptomatic AAA: ≥5.5 cm (or >4.0 cm and rapidly growing)

Contributors

Expert advisers

Greg McMahon, MD, FRCS

Consultant Vascular Surgeon

University Hospitals of Leicester NHS Trust

Honorary Lecturer, College of Life Sciences

University of Leicester

Leicester

UK

Disclosures

GM declares that he has no competing interests.

Acknowledgements,

BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:

Matt J. Bown MB BCh, MD, FRCS, PGCert (Bioinformatics)

Professor of Vascular Surgery

Department of Cardiovascular Sciences

University of Leicester, Leicester Royal Infirmary

Leicester

UK

Andrew Duncan MBBS, BSc, MRCS

Honorary Research Fellow

Department of Cardiovascular Sciences

University of Leicester

Leicester

UK

Disclosures

MJB has grant funding from the British Heart Foundation and the National Institute for Health Research. AD declares that he has no competing interests.

Peer reviewers

Ian Chetter, MBChb, FRCS (eng), MD, FRCS (Gen surg), PGCert Medical Ultrasound, PGDip Clinical Education

Chair of Surgery

University of Hull

Honorary Consultant Vascular Surgeon

Hull University Teaching Hospitals NHS Trust

Hull

United Kingdom

Disclosures

IC declares he has no competing interests

Editors

Annabel Sidwell,

Section Editor, BMJ Best Practice

Disclosures

AS declares that she has no competing interests.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

Disclosures

RW declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

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