Aneurisma aórtico abdominal
Resumen
Definición
El AAA es una dilatación patológica permanente de la aorta con un diámetro >1,5 veces el diámetro anteroposterior (PA) esperado de ese segmento, dado el sexo y el tamaño corporal del paciente.[1][2] El umbral más comúnmente adoptado es un diámetro de 3 cm o más.[2][3] Más del 90% de los aneurismas se originan debajo de las arterias renales.[4]
[Figure caption and citation for the preceding image starts]: Ultrasonido de un AAA de 3.8 cm x 4.2 cmUniversity of Michigan, específicamente los casos del Dr. Upchurch que reflejan los Departamentos de Cirugía Vascular y Radiología [Citation ends].
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- masa abdominal pulsátil palpable
Other diagnostic factors
- dolor abdominal, en fosa lumbar o de espalda
- hipotensión
- Pérdida del conocimiento
- palidez
- distensión abdominal
- fiebre
Risk factors
- tabaquismo
- hereditario/antecedentes familiares
- mayor edad
- sexo masculino (prevalencia)
- sexo femenino (rotura)
- congénito/trastornos del tejido conjuntivo
- hiperlipidemia
- Enfermedad pulmonar obstructiva crónica (EPOC)
- aterosclerosis (es decir, arteriopatía coronaria, enfermedad arterial periférica oclusiva)
- hipertensión
- obesidad central
- no diabético
- uso de antibióticos de fluoroquinolona
- aneurismas en otras partes del cuerpo
Diagnostic tests
1st tests to order
- Ecografía aórtica
Tests to consider
- Angiografía por TC (ATC)
- pruebas cruzadas
- prueba de coagulación
- velocidad de sedimentación globular (VSG)/proteína C-reactiva (PCR)
- hemograma completo (HC)
- hemocultivos
- TEP/TC
Treatment algorithm
aneurisma aórtico abdominal roto (AAA)
aneurisma aórtico abdominal (AAA) sintomático, pero no roto
hallazgo incidental de aneurisma de aorta abdominal asintomático (AAA): <5,5 cm (pero no >4,0 cm y de rápido crecimiento)
hallazgo incidental de aneurisma de aorta abdominal (AAA) asintomático: ≥5,5 cm (o >4,0 cm y de rápido crecimiento)
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 has received honoraria from Gore Medical and Terumo Aortic, manufacturers of abdominal aortic aneurysm stent grafts, for educational and training activities.
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
UK
Declarações
IC declares he has no competing interests
Créditos aos pareceristas
Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.
Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Editores
Annabel Sidwell
Section Editor, BMJ Best Practice
Declarações
AS declares that she has no competing interests.
Rachel Wheeler
Lead Section Editor, BMJ Best Practice
Declarações
RW declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
Declarações
AM declares that he has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
Declarações
JC declares that she has no competing interests.
Referências
Principais artigos
Wanhainen A, Van Herzeele I, Bastos Goncalves F, et al. Editor's choice - European Society for Vascular Surgery (ESVS) 2024 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg. 2024 Feb;67(2):192-331.Texto completo Resumo
National Institute for Health and Care Excellence. Abdominal aortic aneurysm: diagnosis and management. March 2020 [internet publication].Texto completo
Royal College of Emergency Medicine. Management and transfer of patients with a diagnosis of ruptured abdominal aortic aneurysm to a specialist vascular centre. January 2019 [internet publication].Texto completo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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