Abdominal aortic aneurysm

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.[1]Dehlin JM, Upchurch GR. Management of abdominal aortic aneurysms. Curr Treat Options Cardiovasc Med. 2005 Jun;7(2):119-30. http://www.ncbi.nlm.nih.gov/pubmed/15935120?tool=bestpractice.com [2]Johnston KW, Rutherford RB, Tilson MD, et al. Suggested standards for reporting on arterial aneurysms. J Vasc Surg. 1991 Mar;13(3):452-8. http://www.ncbi.nlm.nih.gov/pubmed/1999868?tool=bestpractice.com The most commonly adopted threshold is a diameter of 3 cm or more.[3]Owens DK, Davidson KW, Krist AH, et al; US Preventive Services Task Force. Screening for abdominal aortic aneurysm: US Preventive Services Task Force recommendation statement. JAMA. 2019 Dec 10;322(22):2211-8. https://jamanetwork.com/journals/jama/fullarticle/2757234 http://www.ncbi.nlm.nih.gov/pubmed/31821437?tool=bestpractice.com More than 90% of aneurysms originate below the renal arteries.[4]McConathy WJ, Alaupovic P, Woolcock N, et al. Lipids and apolipoprotein profiles in men with aneurysmal and stenosing aorto-iliac atherosclerosis. Eur J Vasc Surg. 1989 Dec;3(6):511-4. http://www.ncbi.nlm.nih.gov/pubmed/2625160?tool=bestpractice.com [Figure caption and citation for the preceding image starts]: Ultrasound of a 3.8 cm x 4.2 cm AAAUniversity of Michigan/Dr G.R. Upchurch, Departments of Vascular Surgery and Radiology [Citation ends].