The Asymptomatic AAA: When to Be Concerned and What to Tell Your Patient?

Abstract

Asymptomatic abdominal aortic aneurysms (AAAs) are increasingly common incidental findings and will likely be encountered periodically by the acute care provider. Due to the extremely high morbidity and mortality of AAA rupture, providers must recognize the long-term importance of the asymptomatic AAA, identify risk factors for rupture, and provide patients with education and appropriate follow-up. All patients with an AAA should follow with vascular surgery, but those with AAA > 5.5 cm maximal diameter in men and > 5.0 cm in women should be urgently evaluated by a vascular surgeon, as these aneurysms are high risk for rupture and are frequently considered for elective repair. Those with AAA expansion >0.5 cm in 6 months need the same urgent evaluation. Other risk factors such as female gender, active smoking, COPD, and uncontrolled hypertension also increase the risk of expansion and rupture and should prompt expedited surgical evaluation.