Patients are usually asymptomatic and their abdominal aortic aneurysm is detected incidentally. In the minority of patients who experience symptoms, abdominal, back, and groin pain are typical.
Ultrasound remains the definitive test for initial diagnosis and screening. Imaging with computed tomography angiography or magnetic resonance angiography is used for anatomical mapping to assist with operative planning.
For AAA detected as an incidental finding, surveillance is preferred to repair until the theoretical risk of rupture exceeds the estimated risk of operative mortality. Repair is indicated in patients with large asymptomatic AAA.
Mortality during elective surgical repair is higher for women than men for both open repair (7.0% vs. 5.2%) and endovascular aneurysm repair (EVAR) (2.1% vs. 1.3%).
Complications of treatment include acute kidney injury, limb ischemia, spinal cord ischemia, anastomotic pseudoaneurysm, graft infection, graft limb occlusion, and distal embolization. Endoleak is a complication of EVAR.
Abdominal aortic aneurysm (AAA) is a permanent pathologic dilation of the aorta with a diameter >1.5 times the expected anteroposterior (AP) diameter of that segment, given the patient's sex and body size. The most commonly adopted threshold is a diameter of 3 cm or more. More than 90% of aneurysms originate below the renal arteries.
History and exam
Key diagnostic factors
- palpable pulsatile abdominal mass
Other diagnostic factors
- abdominal, back, or groin pain
- cigarette smoking
- hereditary/family history
- increased age
- male sex (prevalence)
- female sex (rupture)
- congenital/connective tissue disorders
- atherosclerosis (i.e., coronary artery disease [CAD], peripheral arterial occlusive disease)
- increased height
- central obesity
1st investigations to order
- abdominal ultrasound
Investigations to consider
- erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP)
- blood cultures
- computed tomography angiography (CTA)/CT
- magnetic resonance angiography (MRA)/MRI
symptomatic, but not ruptured AAA
incidental finding: small asymptomatic AAA
incidental finding: large asymptomatic AAA
endovascular repair leak requiring treatment
- Ureteric colic
- Irritable bowel syndrome (IBS)
- Screening for abdominal aortic aneurysm: US Preventive Services Task Force recommendation statement
- European Society for Vascular Surgery clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms
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