Retrospective Analysis of Giant Abdominal Aortic Aneurysms in a Department of Medicine

Abstract

To the Editor: Abdominal aortic aneurysms (AAAs) occur in up to 9% of adults aged 65 and older, 96% are <4 cm in diameter.1 Aneurysm size is the most important factor related to likelihood of rupture, and the risk is substantially greater in large aneurysms. The annual rupture risk for AAAs larger than 8 cm in diameter is 30% to 50%.1 The clinical presentation is extremely variable. Only a few cases of giant AAAs, with a maximum diameter >14 cm have been reported in the English literature. The objective of this study was to assess the prevalence and characteristics of giant AAAs in a department of internal medicine. All individuals consecutively admitted to the department of internal medicine between January 2009 and December 2010 were retrospectively evaluated for clinical examination, chest X-ray, echocardiogram, and abdominal ultrasound. Three individuals with giant AAAs were identified in 1,285 individuals examined (0.2%) (1 female, 2 male; aged 78, 84, and 81). Thoracoabdominal computed tomography (CT) was performed in all three. Two were hospitalized for melena and anemia and one for abdominal pain. Physical examination revealed in all three a pulsatile, well-defined, abdominal mass, and a mild bruit was heard on auscultation. All had a history of smoking, hypertension, and hyperlipidemia. Abdominal CT with intravenous administration of contrast material revealed large infrarenal aortic aneurysms measuring 11 cm (Figure 1), 13 cm, and 13.4 cm in diameter, respectively, with mural thrombi and extending to the aortic bifurcation and proximal iliac arteries. All cases were managed using open surgical repair, because anatomical factors prevented an endovascular approach. The size of the aneurysms, the short length of the necks, and the dislodgement of abdominal organs that may be densely adhered to the surface of the aneurysm with fistula formation make surgery challenging.2 The clinical presentation of giant AAAs is variable; the most-frequent clinical associations are anemia, melena, epigastric pain, dyspnea, and hemoptysis.2 In conclusion, the repair of these giant aneurysms is challenging surgery because aortic clamping can be difficult because of their size. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: All authors: study concept and design, acquisition of subjects, analysis and interpretation of data, preparation of manuscript. Sponsor's Role: None.