Prevention/detection/management of abdominal aortic aneurysm

Abstract

Risk factors for abdominal aortic aneurysm (AAA) are age, cigarette smoking, dyslipidemia, increased blood pressure, male sex, and family history. An AAA is diagnosed if the aortic anteroposterior diameter is 3 cm or larger. Men aged 60 years and older who are siblings or offspring of patients with an AAA should undergo physical examination and ultrasound screening for detection of an AAA (class I indication). Men who are 65 to 75 years of age who have ever smoked should undergo a physical examination and a 1-time ultrasound screening for detection of an AAA (class IIa indication). Guidelines recommend that patients with an AAA should undergo intensive risk factor modification. In patients that have evidence of back, abdominal, or groin pain in the presence of a pulsatile abdominal mass, the aorta needs to be evaluated immediately, preferably with computed tomographic scanning. In patients with abdominal and/or back pain, a pulsatile abdominal mass, and hypotension, immediate surgical evaluation is indicated (class I indication). In patients with symptomatic AAAs, repair is indicated regardless of AAA diameter (class I indication). Guidelines recommend that patients with infrarenal or juxtarenal AAAs measuring 5.5 cm or larger in diameter should undergo endovascular or open repair to eliminate the risk of rupture (class I indication). Patients with infrarenal or juxtarenal AAAs measuring 4.0 to 5.4 cm in diameter should be monitored by ultrasound or computed tomographic scans every 6 to 12 months to detect expansion (class I indication).