Abdominal aortic aneurysm (AAA)

Abdominal aortic aneurysm (AAA)

Introduction

Localized enlargement of the abdominal aorta such that the diameter is > 3 cm or > 50% larger than normal diameter.


Aetiology

Risk factors:

  • Advanced age
  • Tobacco use
  • Hypertension
  • Hypercholesterolemia
  • Chronic obstructive pulmonary disease (COPD)
  • Male gender

Associated conditions:

  • Atherosclerosis (M/C associated pathology)
  • Cystic medial necrosis
  • Aortic dissection
  • Syphilis
  • HIV
  • Ehlers-Danlos syndrome

Clinical Features

Majority of AAA are identified incidentally during an examination for another unrelated pathology. Most individuals are asymptomatic.

  • Non-tender pulsatile abdominal mass
  • Abdominal, flank or back pain (seen in enlarging aneurysms).
  • Gastrointestinal (GI) or renal manifestations (compression of adjacent viscera)

Complications

Ruptured AAA (rAAA):

Most patients with a ruptured abdominal aortic aneurysm die before hospital arrival (90% mortality rate)
  • Present in shock often with diffuse abdominal pain and distension
Ruptured abdominal aortic aneurysm. | Contributed by Achala Donuru, MD

Inflammatory AAA:

Characterized by intense inflammation, a thickened peel, and adhesions to adjacent structures

Diagnosis

Imaging:

  • USG (best initial investigation)
  • CT, MRA, aortic angiography

Management

Open surgical repair via transabdominal/retroperitoneal approach

GOLD STANDARD
  • Indications:
    • Symptomatic cases (irrespective of size)
    • Rapidly growing aneurysms
    • Aneurysms > 5.5 cm

Endovascular repair via femoral arterial approach:

Recommended in cases not candidates for open surgery: patients with severe heart disease, and/or other comorbidities that preclude open repair.

Summary:


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