Aneurisma da aorta abdominal
Summary
Definition
O AAA é uma dilatação patológica permanente da aorta com um diâmetro >1.5 vez o diâmetro anteroposterior (AP) esperado para esse segmento, considerando o sexo e o tamanho corporal do paciente.[1][2] O limiar mais comumente adotado é um diâmetro de 3 cm ou mais.[2][3] Mais de 90% dos aneurismas se originam abaixo das artérias renais.[4]
[Figure caption and citation for the preceding image starts]: Ultrassonografia de aneurisma da aorta abdominal (AAA) de 3.8 x 4.2 cmUniversity of Michigan, mais especificamente os casos do Dr. Upchurch, representando os Departamentos de Cirurgia vascular e Radiologia [Citation ends].
History and exam
Key diagnostic factors
- presença de fatores de risco
- massa abdominal pulsátil e palpável
Other diagnostic factors
- dor abdominal, nos flancos ou nas costas
- hipotensão
- perda de consciência
- palidez
- distensão abdominal
- febre
Risk factors
- tabagismo
- história familiar/hereditária
- envelhecimento
- sexo masculino (prevalência)
- sexo feminino (ruptura)
- distúrbios congênitos/do tecido conjuntivo
- hiperlipidemia
- Doença pulmonar obstrutiva crônica (DPOC)
- aterosclerose (ou seja, doença arterial coronariana [DAC], doença arterial oclusiva periférica)
- hipertensão
- obesidade central
- não diabético
- uso de antibióticos fluoroquinolonas
- aneurismas em qualquer outra parte do corpo
Diagnostic tests
1st tests to order
- ultrassonografia aórtica
Tests to consider
- angiotomografia (ATG)
- prova cruzada
- exames de coagulação
- velocidade de hemossedimentação (VHS)/proteína C-reativa
- Hemograma completo
- hemoculturas
- tomografia computadorizada por emissão de pósitrons (PET-CT)
Treatment algorithm
aneurisma roto da aorta abdominal (AAA)
aneurisma da aorta abdominal (AAA) sintomático, mas não roto
achado incidental de aneurisma da aorta abdominal (AAA) assintomático: <5.5 cm (mas não >4.0 cm e crescendo rapidamente)
achado incidental de aneurisma da aorta abdominal (AAA) assintomático: ≥5.5 cm (ou >4.0 cm e crescendo rapidamente)
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
Disclosures
IC declares he has no competing interests
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
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.
References
Key articles
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.Full text Abstract
National Institute for Health and Care Excellence. Abdominal aortic aneurysm: diagnosis and management. March 2020 [internet publication].Full text
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].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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