Abdominal Aortic Aneurysm (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Abdominal aortic aneurysm facts
- What is an aneurysm?
- What is an aortic aneurysm?
- What is the thoracic and abdominal aorta?
- Where do aortic aneurysms tend to develop?
- What shape are most aortic aneurysms?
- What is inside an aortic aneurysm?
- Who is most likely to have an abdominal aortic aneurysm?
- What are risk factors for aortic aneurysms?
- What is the most common cause of aortic aneurysms?
- What are other causes of aortic aneurysms?
- What are the symptoms of an abdominal aortic aneurysm?
- How is an abdominal aortic aneurysm diagnosed clinically?
- What tests help in the diagnosis of an abdominal aortic aneurysm?
- What is the natural history of abdominal aortic aneurysms?
- What are the complications with an abdominal aortic aneurysm?
- How are abdominal aortic aneurysms repaired?
- What is done if an abdominal aortic aneurysm threatens to rupture?
- What is the medical management (nonsurgical management) of abdominal aortic aneurysm?
How is an abdominal aortic aneurysm diagnosed clinically?
Physical examination can be the initial way the diagnosis of abdominal aortic aneurysm is made. The health care professional may be able to feel a pulsatile mass in the center of the abdomen and make the clinical diagnosis. In obese patients with a large girth, physical exam is less helpful. In very thin patients, the aorta can often be seen to pulsate under the skin and this may be a normal finding. Listening with a stethoscope may also reveal a bruit or abnormal sound from turbulence of blood within the aneurysm.
What tests help in the diagnosis of an abdominal aortic aneurysm?
In most cases, X-rays of the abdomen show calcium deposits in the aneurysm wall. But plain X-rays of the abdomen cannot determine the size and the extent of the aneurysm. Ultrasonography usually gives a clear picture of the size of an aneurysm. Ultrasound has about 98% accuracy in measuring the size of the aneurysm and is safe and noninvasive. Computerized tomography of the abdomen is highly accurate in determining the size and extent of the aneurysm and its location in the aorta. To help plan repair, if needed, it is important to know whether the aneurysm is above or below where the renal arteries branch off to go to the kidneys and whether the aneurysm extends towards the chest or down into the iliac arteries into the legs. CT scans require dye to be injected to evaluate the blood vessels (including the aorta). Patients with kidney disease or dye allergies may not be candidates for CT. MRI/MRA (magnetic resonance imaging and arteriography) may be an alternative.
An aortogram, an X-ray study where dye is directly injected into the aorta, was the test of choice, but CT and MRI have taken its place.
What is the natural history of abdominal aortic aneurysms?
Abdominal aortic aneurysms gradually expand over time. The larger the aneurysm, the greater the risk of rupture and death. Small aneurysms can be observed and followed with repeated ultrasounds or other imaging.
Guidelines for following an aneurysm are as follows:
- A normal aorta measures up to 1.7 cm in a male and 1.5 cm in a female.
- Aneurysms that are found incidentally or by accident that are less than 3.0 cm do not need to be re-evaluated or followed.
- Aneurysms measuring 3.0 to 4.0 cm should be rechecked by ultrasound every year to monitor for potential enlargement and dilation.
- Aneurysms measuring 4.0 to 4.5 cm should be monitored every 6 months by ultrasound.
- Aneurysms measuring greater than 4.5 cm should be evaluated by a surgeon for potential repair.
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