Abdominal aortic aneurysm

Not to be confused with Aortic dissection.
Abdominal aortic aneurysm
three white arrows pointing to an enlargement of the abdominal aorta
CT reconstruction image of an abdominal aortic aneurysm (white arrows)
SpecialtyVascular surgery
SymptomsNone, abdominal, back, or leg pain[1][2]
Usual onsetOver-50-year-old males[1]
Risk factorsSmoking, hypertension, other cardiovascular disease, family history, Marfan syndrome[1][3][4]
Diagnostic methodMedical imaging (abdominal aorta diameter > 3 cm)[1]
PreventionNot smoking, treating risk factors[1]
TreatmentSurgery (open surgery or endovascular aneurysm repair)[1]
Frequency~5% (males over 65 years)[1]
Deaths168,200 aortic aneurysms (2015)[5]

Abdominal aortic aneurysm (AAA) is a localized enlargement of the abdominal aorta such that the diameter is greater than 3 cm or more than 50% larger than normal.[1] An AAA usually causes no symptoms, except during rupture.[1] Occasionally, abdominal, back, or leg pain may occur.[2] Large aneurysms can sometimes be felt by pushing on the abdomen.[2] Rupture may result in pain in the abdomen or back, low blood pressure, or loss of consciousness, and often results in death.[1][6]

AAAs occur most commonly in men, those over 50 and those with a family history of the disease.[1] Additional risk factors include smoking, high blood pressure, and other heart or blood vessel diseases.[3] Genetic conditions with an increased risk include Marfan syndrome and Ehlers–Danlos syndrome.[4] AAAs are the most common form of aortic aneurysm.[4] About 85% occur below the kidneys, with the rest either at the level of or above the kidneys.[1] In the United States, screening with abdominal ultrasound is recommended for males between 65 and 75 years of age with a history of smoking.[7] In the United Kingdom and Sweden, screening all men over 65 is recommended.[1][8] Once an aneurysm is found, further ultrasounds are typically done on a regular basis.[2]

Abstinence from cigarette smoking is the single best way to prevent the disease.[1] Other methods of prevention include treating high blood pressure, treating high blood cholesterol, and avoiding being overweight.[1] Surgery is usually recommended when the diameter of an AAA grows to >5.5 cm in males and >5.0 cm in females.[1] Other reasons for repair include the presence of symptoms and a rapid increase in size, defined as more than one centimeter per year.[2] Repair may be either by open surgery or endovascular aneurysm repair (EVAR).[1] As compared to open surgery, EVAR has a lower risk of death in the short term and a shorter hospital stay, but may not always be an option.[1][9][10] There does not appear to be a difference in longer-term outcomes between the two.[11] Repeat procedures are more common with EVAR.[12]

AAAs affect 2-8% of males over the age of 65.[1] They are five times more common in men.[13] In those with an aneurysm less than 5.5 cm, the risk of rupture in the next year is below 1%.[1] Among those with an aneurysm between 5.5 and 7 cm, the risk is about 10%, while for those with an aneurysm greater than 7 cm the risk is about 33%.[1] Mortality if ruptured is 85% to 90%.[1] During 2013, aortic aneurysms resulted in 168,200 deaths, up from 100,000 in 1990.[5][14] In the United States AAAs resulted in between 10,000 and 18,000 deaths in 2009.[4]

  1. ^ a b c d e f g h i j k l m n o p q r s t u v Kent KC (27 November 2014). "Clinical practice. Abdominal aortic aneurysms". The New England Journal of Medicine. 371 (22): 2101–2108. doi:10.1056/NEJMcp1401430. PMID 25427112.
  2. ^ a b c d e Upchurch GR, Schaub TA (2006). "Abdominal aortic aneurysm". American Family Physician. 73 (7): 1198–1204. PMID 16623206.
  3. ^ a b Wittels K (November 2011). "Aortic emergencies". Emergency Medicine Clinics of North America. 29 (4): 789–800, vii. doi:10.1016/j.emc.2011.09.015. PMID 22040707.
  4. ^ a b c d "Aortic Aneurysm Fact Sheet". cdc.gov. July 22, 2014. Archived from the original on 3 February 2015. Retrieved 3 February 2015.
  5. ^ a b GBD 2015 Mortality and Causes of Death Collaborators (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  6. ^ Spangler R, Van Pham T, Khoujah D, Martinez JP (2014). "Abdominal emergencies in the geriatric patient". International Journal of Emergency Medicine. 7 (1): 43. doi:10.1186/s12245-014-0043-2. PMC 4306086. PMID 25635203.
  7. ^ LeFevre ML (19 August 2014). "Screening for abdominal aortic aneurysm: U.S. Preventive Services Task Force recommendation statement". Annals of Internal Medicine. 161 (4): 281–290. doi:10.7326/m14-1204. PMID 24957320. S2CID 265875637.
  8. ^ Svensjö S, Björck M, Wanhainen A (December 2014). "Update on screening for abdominal aortic aneurysm: a topical review". European Journal of Vascular and Endovascular Surgery. 48 (6): 659–667. doi:10.1016/j.ejvs.2014.08.029. PMID 25443524.
  9. ^ Thomas DM, Hulten EA, Ellis ST, Anderson DM, Anderson N, McRae F, Malik JA, Villines TC, Slim AM (2014). "Open versus Endovascular Repair of Abdominal Aortic Aneurysm in the Elective and Emergent Setting in a Pooled Population of 37,781 Patients: A Systematic Review and Meta-Analysis". ISRN Cardiology. 2014: 149243. doi:10.1155/2014/149243. PMC 4004021. PMID 25006502.
  10. ^ Biancari F, Catania A, D'Andrea V (November 2011). "Elective endovascular vs. open repair for abdominal aortic aneurysm in patients aged 80 years and older: systematic review and meta-analysis". European Journal of Vascular and Endovascular Surgery. 42 (5): 571–6. doi:10.1016/j.ejvs.2011.07.011. PMID 21820922.
  11. ^ Paravastu SC, Jayarajasingam R, Cottam R, Palfreyman SJ, Michaels JA, Thomas SM (23 January 2014). "Endovascular repair of abdominal aortic aneurysm". The Cochrane Database of Systematic Reviews. 1 (1): CD004178. doi:10.1002/14651858.CD004178.pub2. PMC 10749584. PMID 24453068.
  12. ^ Ilyas S, Shaida N, Thakor AS, Winterbottom A, Cousins C (February 2015). "Endovascular aneurysm repair (EVAR) follow-up imaging: the assessment and treatment of common postoperative complications". Clinical Radiology. 70 (2): 183–196. doi:10.1016/j.crad.2014.09.010. PMID 25443774.
  13. ^ Bunce NH, Ray R, Patel H (2020). "30. Cardiology". In Feather A, Randall D, Waterhouse M (eds.). Kumar and Clark's Clinical Medicine (10th ed.). Elsevier. pp. 1129–1130. ISBN 978-0-7020-7870-5.
  14. ^ GBD 2013 Mortality Causes of Death Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442.