Abstract
Most abdominal aortic aneurysms (AAAs) are asymptomatic, not detectable on physical examination, and silent until discovered during radiologic testing for other reasons. Tobacco use, hypertension, a family history of AAA, and male sex are clinical risk factors for the development of an aneurysm. Ultrasound, the preferred method of screening, is cost-effective in high-risk patients. Repair is indicated when the aneurysm becomes greater than 5.5 cm in diameter or grows more than 0.6 to 0.8 cm per year. Asymptomatic patients with an AAA should be medically optimized before repair, including institution of beta blockade. Symptomatic aneurysms present with back, abdominal, buttock, groin, testicular, or leg pain and require urgent surgical attention. Rupture of an AAA involves complete loss of aortic wall integrity and is a surgical emergency requiring immediate repair. The mortality rate approaches 90 percent if rupture occurs outside the hospital. Although open surgical repair has been performed safely, an endovascular approach is used in select patients if the aortic and iliac anatomy are amenable. Two large randomized controlled trials did not find any improvement in mortality rate or morbidity with this approach compared with conventional open surgical repair.
Highlights
Patient information: A handout on abdominal aortic aneurysms, written by Jill Giordano, Medical Editing Clerk at Georgetown University Medical Center, is provided on page 1205
It is important that family physicians understand which patients are at risk for the development of abdominal aortic aneurysms (AAAs) and the appropriate evaluation once a patient has been diagnosed with an aneurysm
Patients with an aneurysm less than 5.5 cm in diameter should have follow-up serial ultrasounds (Table 27). These recommendations serve only as guidelines; each patient should be evaluated for the presence of risk factors for accelerated AAA growth and rupture (Table 16,9-14) and for surgical risk and overall health
Summary
Patient information: A handout on abdominal aortic aneurysms, written by Jill Giordano, Medical Editing Clerk at Georgetown University Medical Center, is provided on page 1205. Abdominal aortic aneurysm (AAA) is a relatively common and often fatal condition that primarily affects older patients. AAAs and aortic dissections are responsible for at least 15,000 deaths yearly and in 2000 were the 10th leading cause of death in white men 65 to 74 years of age in the United States.[1] With an aging population, the incidence and prevalence of AAA is certain to rise. Most AAAs are asymptomatic, and physical examination lacks sensitivity for detecting an aneurysm.[2] It is important that family physicians understand which patients are at risk for the development of AAA and the appropriate evaluation once a patient has been diagnosed with an aneurysm
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