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.
Table of Contents
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.
Complications:
- Rupture
- Thrombosis
- Embolism
- Fistulae
- Pressure on surrounding structures.
Diagnosis
- 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
Screening:
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.
Treatment
- 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
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