Abdominal Aortic Aneurysm

Aortic aneurysm means greater than 50% dilation of all three layers of the aortic wall. Aortic aneurysms are most commonly associated with atherosclerosis. Most are abdominal, and > 90% originate below the renal arteries.
■ Ascending aortic aneurysm—think cystic medial necrosis or connective tissue disease.
■ Descending aortic aneurysm—think atherosclerosis.

Risk factors for abdominal aortic aneurysm

  • Hypertension
  • Dyslipidemia,
  • a positive family history,
  • Smoking (the strongest predictor of rupture),
  • Gender (males > females)
  • other peripheral artery diseases,
  • Age.

Sign and symptoms of aortic aneurysm

  • The patient is usually asymptomatic and discovered incidentally on an examination or radiologic study. It may cause mild abdominal or back pain.
  • On examination, it demonstrates a pulsatile abdominal mass or abdominal bruits.
  • Ruptured abdominal aortic aneurysm leads to hypotension and severe tearing abdominal pain that radiates to the back, iliac fossae, or groin, and syncope.


  • Rupture
  • Thrombosis
  • Embolism
  • Fistulae
  • Pressure on surrounding structures.


  • Abdominal ultrasound is used for diagnosis or to follow the course of an aneurysm over time.
  • CT with contrast or MRA may be useful to determine the precise anatomy


All men 65–75 years of age with a history of smoking are recommended for a one-time screening by ultrasound for Abdominal Aortic aneurysm.


Abdominal aortic aneurysm
  • In asymptomatic patients, monitoring is appropriate for lesions < 5 cm.
  • Surgical correction is indicated if the lesion is ≥ 5.5 cm (abdominal), > 6 cm (thoracic), or smaller but rapidly enlarging (watch for bowel ischemia and infarction).
  • Emergent surgery for symptomatic or ruptured aneurysms


  1. https://www.nejm.org/doi/10.1056/NEJMcp1401430

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