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 of 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 aneurysm?
- 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?
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.
What are the complications with an abdominal aortic aneurysm?
An aortic aneurysm can leak causing an increase in the patient's abdominal pain. When pain is felt in the back or flank, the symptoms can be misdiagnosed as a kidney stone. If the diagnosis is missed or if the patient does not present for care, the aneurysm can burst or rupture causing potential catastrophe and death.
Since aneurysms are associated with atherosclerosis and plaque along the aortic wall and since aneurysms often contain a clot, debris can travel, or embolize, into smaller blood vessels and cause symptoms due to decreased blood flow.
Aneurysms can rarely become infected.
How are abdominal aortic aneurysms repaired?
Each patient is different and the decision to repair an abdominal aortic aneurysm depends upon the size of the aneurysm, the age of the patient, underlying medical conditions, and life expectancy.
There are two approaches for repair:
The first is the traditional surgical approach. A large incision is made in the abdomen, the aortic aneurysm is identified and cut out or resected. The missing piece of aorta is replaced with a synthetic graft.
The second approach is placing an endovascular graft. A catheter or tube is threaded into the femoral artery in the groin and the graft is positioned so that it spans and sits inside the aneurysm and protects it from expanding (endovascular: endo = inside + vascular = blood vessel).
The approach to treatment needs to be tailored to the individual patient and very much depends upon the location, size, and shape of the aneurysm.
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