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].
Анамнез и осмотр
Ключевые диагностические факторы
- presença de fatores de risco
- massa abdominal pulsátil e palpável
Другие диагностические факторы
- dor abdominal, nos flancos ou nas costas
- hipotensão
- perda de consciência
- palidez
- distensão abdominal
- febre
Факторы риска
- 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
Диагностические исследования
Исследования, которые показаны в первую очередь
- ultrassonografia aórtica
Исследования, проведение которых нужно рассмотреть
- 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)
Алгоритм лечения
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)
Составители
Эксперты-консультанты
Greg McMahon, MD, FRCS
Consultant Vascular Surgeon
University Hospitals of Leicester NHS Trust
Honorary Lecturer, College of Life Sciences
University of Leicester
Leicester
UK
Раскрытие информации
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
Раскрытие информации
MJB has grant funding from the British Heart Foundation and the National Institute for Health Research. AD declares that he has no competing interests.
Рецензенты
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
Раскрытие информации
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.
Редакторы
Annabel Sidwell
Section Editor, BMJ Best Practice
Раскрытие информации
AS declares that she has no competing interests.
Rachel Wheeler
Lead Section Editor, BMJ Best Practice
Раскрытие информации
RW declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
Раскрытие информации
AM declares that he has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
Раскрытие информации
JC declares that she has no competing interests.
Список литературы
Основные статьи
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.Полный текст Аннотация
National Institute for Health and Care Excellence. Abdominal aortic aneurysm: diagnosis and management. March 2020 [internet publication].Полный текст
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].Полный текст
Статьи, указанные как источники
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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