Abdominal Aortic Aneurysm

An abdominal aortic aneurysm (AAA) is often asymptomatic until complications such as rupture occur. Prevalence in those aged 50–84 years is 1.4% in the USA. Typically, AAAs are incidentally detected during imaging for other disorders. Risk factors include old age, male gender, and smoking; there is an association with vascular disorders, hypertension, and hyperlipidemia. Once diagnosed, an AAA requires regular surveillance through imaging. Medical management includes addressing the risk factors, control of hypertension and hyperlipidemia, smoking cessation, and watchful waiting with surveillance. Elective surgery is recommended for aneurysms that continue to enlarge during surveillance or are larger than 5.5 cm. In the event of rupture, mortality is high in spite of emergency surgery. The USPSTF recommendation is for a onetime ultrasonographic screening for AAA in males aged 65 or older; this is associated with decreased AAA rupture and AAA-related mortality rates but with no effect on all-cause mortality rates. Ultrasonography is the preferred imaging modality for screening and surveillance; it has high sensitivity and specificity; in the event of suspected rupture or bleeding, a CT scan or MRI becomes the modality choice for imaging. Risk factors that are modifiable should be addressed. Surgical approaches include endovascular aortic aneurysm repair and open surgical repair; endovascular approach offers better outcomes in terms of morbidity and mortality.