Most abdominal aneurysms are identified during routine medical exams. While the exact causes of abdominal aortic aneurysm are not clear, there are some risk factors associated with abdominal aortic aneurysm:. If your doctor sees signs of an abdominal aortic aneurysm, he or she may arrange for special tests to confirm the diagnosis. Usually, these will involve imaging of your abdomen using magnetic resonance imaging MRI , computerized tomography CT , and ultrasound imaging.
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Cardiac or renal transplant 11 ; decreased forced expiratory volume in one second 12 ; female sex two- to fourfold increase in risk of rupture 12 ; higher mean blood pressure 12 ; larger initial AAA diameter 13 ; current tobacco use length of time smoking is more significant than amount smoked Information from references 6 and 9 through Abdominal examination in a patient with a suspected AAA should include deep manipulation to elicit pain on aortic palpation.
The abdominal aorta may be palpated as part of a normal physical examination without being frankly aneurysmal. However, AAAs in the 3- to 3. The common iliac arteries also may be aneurysmal and palpable in the lower abdominal quadrants. Patients should be examined for the presence of femoral and popliteal pulses and possible aneurysmal dilatation.
The presence of a prominent popliteal or femoral artery pulse warrants an abdominal ultrasound to rule out an AAA and a lower extremity arterial ultrasound to rule out peripheral artery aneurysm. There is a 62 percent chance that an AAA is present with a popliteal aneurysm and an 85 percent chance it is present with a femoral artery aneurysm; 14 percent of patients with a known AAA will have a femoral or popliteal artery aneurysm.
Patients who are diagnosed with an AAA, deny pain, and are clinically stable should be triaged based on the size of the aneurysm Figure 2 Two large prospective studies 18 , 19 determined independently that surveillance in compliant male patients with an aneurysm 4 to 5.
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Patients with aneurysms greater than or equal to 5. Because most clinically diagnosed AAAs are repaired, their long-term natural history is difficult to predict.
The one-year incidence of rupture is 9 percent for aneurysms 5. These recommendations serve only as guidelines; each patient should be evaluated for the presence of risk factors for accelerated AAA growth and rupture Table 1 6 , 9 — 14 and for surgical risk and overall health. Information from reference 7. Traditionally, if the AAA expands by more than 0.
All patients with AAAs should be educated on the signs of symptomatic and ruptured aneurysms. If they experience new or unusual pain in the back, groin, testicles, legs, or buttocks, emergent medical attention should be sought. In patients presenting with back, abdominal, or groin pain in the presence of a pulsatile abdominal mass, the aorta needs to be evaluated urgently.
If the patient is clinically stable, an urgent computed tomography CT scan should be obtained Figure 3 to determine the presence and size of the aorta, as well as to rule out a ruptured AAA. Outcomes for repair of symptomatic AAAs are significantly worse than for asymptomatic aneurysms. Postoperative morbidity of patients undergoing symptomatic AAA repair is similar to those undergoing ruptured AAA repair.
Three-dimensional computed tomography scan of an abdominal aortic aneurysm in a patient presenting with abdominal pain documenting an intact, but symptomatic aneurysm. The classic presentation of a ruptured AAA includes the triad of hypotension, abdominal or back pain, and a pulsatile abdominal mass. In a study 25 of patients with ruptured AAAs, 45 percent were hypotensive, 72 percent had pain, and 83 percent had a pulsatile abdominal mass.
Patients with ruptured AAAs need immediate intervention to prevent death. Despite advances in perioperative care leading to significant decreases in mortality following AAA repair in asymptomatic patients, postoperative mortality following ruptured AAA repair is still more than 40 percent in patients who survive the operation.
When evaluating asymptomatic patients before AAA repair, it is important to optimize their comorbidities, particularly cardiac, pulmonary, and renal functions. Patients with coronary artery disease should undergo beta blockade. The dosage was increased to a maximum of 10 mg once daily if resting heart rate was still greater than 60 beats per minute approximately one week after institution of therapy.
Bisoprolol was withheld if the heart rate was less than 50 beats per minute or the systolic blood pressure fell to less than mm Hg. Death from cardiac causes or nonfatal myocardial infarction occurred in 3. A recent meta-analysis 28 has confirmed this benefit in high-risk patients but not in low-risk patients. These data were not extrapolated to patients with unstable angina, aortic stenosis, or severe left ventricular dysfunction, and it was postulated that medical optimization before repair may have contributed to improved outcomes.
Therefore, preoperative cardiac evaluation, including use of cardiac medications, is appropriate in certain patients who are to undergo elective open AAA repair.
The cardiovascular evaluation is intended to reduce perioperative risk and improve long-term survival. There are insufficient data to justify a reduced preoperative cardiology work-up before endovascular repair. Patients with chronic obstructive pulmonary disease have a higher risk of major clinical complications from AAA, particularly in the presence of concurrent cardiac disease, suboptimal chronic obstructive pulmonary disease management, or chronic renal disease.
A study 34 of 8, intact and 1, ruptured AAA repairs showed that impaired renal function has a strong effect on mortality.
The mortality rate was Similar results were found in patients undergoing repair of a ruptured AAA. The two primary methods of AAA repair are open and endovascular.
Before repair, a CT scan of the aorta and iliac arteries is required Table 3 Traditional open AAA repair involves direct access to the aorta through an incision in the abdomen. This repair method is well established as definitive, requiring essentially no follow-up radiologic studies.
The majority of patients undergoing open AAA repair remain without significant graft-related complications during the rest of their lives 0. Symptoms of an abdominal aortic aneurysm AAA AAAs do not usually cause any obvious symptoms, and are often only picked up during screening or tests carried out for another reason. Some people with an AAA have: a pulsing sensation in the tummy like a heartbeat tummy pain that does not go away lower back pain that does not go away If an AAA bursts, it can cause: sudden, severe pain in the tummy or lower back dizziness sweaty, pale and clammy skin a fast heartbeat shortness of breath fainting or passing out Call for an ambulance immediately if you or someone else develops symptoms of a burst AAA.
When to get medical help Make an appointment to see a GP as soon as possible if you have symptoms, especially if you're at a higher risk of an AAA. People at a higher risk of getting an AAA include all men aged 66 or over and women aged 70 or over who have one or more of the following risk factors: high blood pressure chronic obstructive pulmonary disease high blood cholesterol a family history of AAA cardiovascular disease, such as heart disease or a history of stroke they smoke or have previously smoked Speak to a GP if you're worried you may be at risk of an AAA.
Treatment for a: small AAA 3cm to 4. Reducing your risk of an abdominal aortic aneurysm AAA There are several things you can do to reduce your chances of getting an AAA or help stop one getting bigger. These include: stopping smoking — read stop smoking advice and find out about Smokefree , the NHS stop smoking service eating healthily — eat a balanced diet and cut down on fatty food exercising regularly — aim to do at least minutes of exercise a week ; read about how to get started with some common activities maintaining a healthy weight — use the healthy weight calculator to see if you need to lose weight, and find out how to lose weight safely cutting down on alcohol — read tips on cutting down and general advice about alcohol If you have a condition that increases your risk of an AAA, such as high blood pressure, your GP may also recommend taking tablets to treat this.
Video: abdominal aortic aneurysm This video shows what an abdominal aortic aneurysm looks like. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter.
Show references Dalman RL, et al. Overview of abdominal aortic aneurysm. Accessed July 27, Spryngerd M, et al. Screening program of abdominal aortic aneurysm. Abdominal aortic aneurysms AAA. Merck Manual Professional Version. Abdominal aortic aneurysm: Screening.
Preventive Services Task Force. Accessed July 20,
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