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Abdominal aortic aneurysm Last updated: February 9, 2023

Summary

Definition

Epidemiology

Etiology

Classification

Pathophysiology

Clinical features

Diagnostics

Differential diagnoses

Treatment

Abdominal aortic aneurysm rupture

Complications

Abdominal aortic aneurysm rupture

Embolism: caused by thrombotic material from the aneurysm

Aortic dissection

Postoperative complications [19]

Ischemia of the bowel, kidneys, and spinal cord

Anterior spinal artery occlusion

Prosthetic graft infection

Aortoenteric fistula

Complications following EVAR [1]

Endoleak

Access site complications, e.g., bleeding, hematoma, false aneurysm

Graft limb thrombosis

We list the most important complications. The selection is not exhaustive.

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Acute management checklist for abdominal aortic aneurysm

Ruptured abdominal aortic aneurysm

Immediate vascular surgery consult for emergency surgical repair if ruptured aneurysm is suspected

Unstable patients: Transfer to the OR immediately.

Stable patients: Consider CTA if it can be performed rapidly and close monitoring is possible.

NPO

IV access with two large-bore peripheral IV lines

Check CBC, type and screen, obtain patient consent for blood transfusion, and order pRBCs (prepare
for massive transfusion protocol).
[1][20]
IV fluid resuscitation with goal SBP of 70–90 mm Hg (permissive hypotension)

IV opioid analgesics

Symptomatic abdominal aortic aneurysm

Urgent vascular surgery consult for surgical repair

CT angiography abdomen and pelvis with IV contrast for preintervention planning if patient is
hemodynamically stable

Transfer to OR.

NPO

IV access with two large-bore peripheral IV lines

Check CBC, type and screen, obtain patient consent for blood transfusion, and order pRBCs (prepare
for massive transfusion protocol).

Consider IV fluid resuscitation.

IV opioid analgesics

Prevention

Primary prevention [1]

See “ASCVD prevention” for detailed information on primary prevention.

The following measures are thought to reduce the risk of developing an AAA:

Eating nuts, fruits, and vegetables more than three times a week

Exercising more than once a week

Smoking cessation

Secondary prevention (screening for AAA) [1][2]

Indications
[1][2]
Men aged 65–75 years with a history of smoking (ever smokers)

Consider screening:
[1][2]
Individuals aged 65–75 years with a family history of AAA in a first-degree relative
[1][2]
Women aged 65–75 years with a history of smoking (ever smokers)

Individuals aged > 75 years with no previous screening and a history of smoking or family history
[1][21]
of AAA

Modality: abdominal ultrasound [1][2][6]

Frequency

One-time screening is recommended. [2]

Consider rescreening after 10 years if the aortic diameter was between 2.5 cm and 3 cm at the initial
assessment. [1]

AAA screening is not recommended for women who have never smoked and have no family
history of AAA. [2]

Tertiary prevention [1]

Elective repair to prevent rupture (see “Treatment”)

[1]
Aneurysm monitoring with ultrasound

Smoking cessation

References

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