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Overview

An abdominal aortic aneurysm is a localized dilatation of the abdominal aorta, that exceeds the normal diameter of the abdominal aorta by more than 50%. The normal diameter of an aorta depends on the patient's age, sex, height, weight, race, body surface area, and baseline blood pressure. On average, the normal diameter of the infrarenal aorta is 2 cm, and therefore a true AAA measures 3.0 cm or more. Aortic ectasia is a mild generalized dilatation (<50% of the normal diameter of ≤ 2.9 cm) that is due to age-related degenerative changes in the vessel walls.

Causes

Life Threatening Causes

Abdominal aortic aneurysm is a life-threatening condition and must be treated as such irrespective of the underlying cause.

• Abdominal trauma
• Bacteremia
• Gastrointestinal perforation
• Vertebral osteomyelitis

Common Causes

• Abdominal trauma
• Atherosclerosis
• Marfan syndrome

FIRE: Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.

Abbreviations:

Complete Diagnostic Approach

A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention.

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Examine the patient:

Characterize the symptoms: ❑ Asymptomatic ❑ Majority of the patients are asymptomatic (Detected incidentally) ❑ Symptomatic but not ruptured ❑ Pain with an indolent onset ❑ Abdominal pain ❑ Back pain ❑ Groin pain (scrotum) ❑ Pulsating sensations in the abdomen ❑ Limb ischemia ❑ Systemic manifestations ❑ Fever ❑ Malaise ❑ Symptomatic and ruptured ❑ Severe pain described as severe, sudden, persistent, or constant ❑ Hypotension ❑ Syncope, fainting (suggestive of hemorrhage) ❑ Anxiety ❑ Palpitation ❑ Sweating ❑ Rapid, weak pulse ❑ Shortness of breath ❑ Rapid breathing ❑ Clammy skin

Obtain a detailed history: ❑ History to find out the risk factors for development of aneurysm ❑ Hyperlipidemia ❑ Connective tissue disorder ❑ Marfan syndrome ❑ Ehlers-Danlos syndrome ❑ Relapsing polychondritis ❑ Pseudoxanthoma elasticum ❑ Polycystic kidney disease ❑ Loeys-Dietz syndrome ❑ COPD (Emphysema) ❑ Hypertension ❑ History to find out the risk factors for expansion of aneurysm ❑ Cardiac or renal transplant ❑ Stroke ❑ Cardiac disease ❑ History to find out the risk factors for rupture of aneurysm ❑ Female gender ❑ Cardiac or renal transplant ❑ Hypertension ❑ Family history ❑ Abdominal aortic aneurysm ❑ Alpha 1-antitrypsin deficiency ❑ Past Medical History ❑ Diabetes mellitus (Negatively associated with AAA) ❑ Atherosclerosis ❑ Peripheral artery disease ❑ Giant cell arteritis ❑ Hemorrhoids ❑ Esophageal varices ❑ Social History ❑ Smoking History (Strongest risk factor) (smoked at some point in their life) ❑ Alcohol History ❑ Anatomic deformities ❑ Bicuspid aortic valve ❑ Coarctation of the aorta ❑ Infections of the aorta (aortitis)(very rare) ❑ Syphilis ❑ Salmonella ❑ Staphylococcus ❑ Trauma ❑ Arteritis ❑ Cystic medial necrosis

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Treatment

Shown below is an algorithm summarizing the treatment of Abdominal aortic aneurysm according the the [...] guidelines.