Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Dilatation of the infrarenal aorta (> 3 cm in diameter) Incidence increases with age and more common in men > 65 years old who have smoked Most are asymptomatic until rupture; then 85% of patients die suddenly before reaching the hospital +++ GENERAL CONSIDERATIONS ++ Up to 4% of men over age 65 have abdominal aortic aneurysm (AAA) by ultrasound screening Autopsy series discover ruptured AAA in 8 of 100,000 men and 3 of 100,000 women Pathologically, AAAs show inflammation involving all 3 layers of the aorta and are characterized by loss of the media and fewer elastin fibers but more collagen After age, smoking is the most common risk factor for AAA Hypertension is associated with rupture but not the development of AAA. Other traditional atherosclerotic risk factors are not associated with AAA – Family history may reveal a hereditary component in some cases +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ Most are asymptomatic and found incidentally Back, abdominal, or flank pain can occur +++ PHYSICAL EXAM FINDINGS ++ Pulsatile abdominal mass +++ DIFFERENTIAL DIAGNOSIS ++ Tumor adjacent to aorta Pulsatile liver from tricuspid regurgitation Musculoskeletal back pain Acute abdomen (eg, pancreatitis) Aortic dissection Ureteric colic +++ DIAGNOSTIC EVALUATION +++ IMAGING STUDIES ++ Abdominal ultrasound is the best initial screening test and best test for serial follow-up CT and MRI scanning are superior for identifying rupture in painful AAAs and planning therapeutic interventions +++ DIAGNOSTIC PROCEDURES ++ Angiography is often misleading and is not recommended +++ TREATMENT +++ CARDIOLOGY REFERRAL ++ Suspicion of heart disease before procedure or surgery +++ HOSPITALIZATION CRITERIA ++ Painful AAA Ruptured AAA Planned intervention +++ MEDICATIONS ++ AAA < 5.5 cm ++ Stop smoking Treat hypertension ++ AAA > 5.5 cm ++ Repair unless risk is prohibitive +++ THERAPEUTIC PROCEDURES ++ Endovascular repair with a percutaneous graft-stent combination is performed in most cases +++ SURGERY ++ Surgical replacement with a synthetic graft if endovascular repair not feasible +++ MONITORING ++ ECG monitoring in hospital Blood pressure in hospital +++ DIET AND ACTIVITY ++ Restrict activity if rupture suspected; exercise stress testing contraindicated +++ ONGOING MANAGEMENT +++ HOSPITAL DISCHARGE CRITERIA ++ After successful procedure or surgery +++ FOLLOW-UP ++ If < 5.5 cm, repeat ultrasound: 3.0–3.4 cm, ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.