Abdominal Aortic Aneurysm

September 25, 2009

 Definition
 Aneurysm: irreversible dilation of an artery at least 1.5
times its normal caliber
 True aneurysm vs. False aneurysm
 Varieties:
 Degenerative – due to atherosclerosis, most common type
 Traumatic – iatrogenic, catheter-related, penetrating trauma
 Poststenotic – Bernoulli’s principle, occurs distally (distal to
coarctation, distal to cervical rib in thoracic outlet syndrome, etc.)
 Dissecting
 Mycotic – infected
 Anastomotic – separation between graft and native artery
 Abdominal Aortic Aneurysm
 Fusiform dilation of abdominal aorta > 1.5 times its
normal diameter
 Incidence: 5% of elderly population >60 years old (6-9
times more common in males)
 Relative risk: 11.6% in patients with first-degree relative
with known AAA
 Risk factors: Atherosclerosis, HTN, smoking, male
gender, advanced age, connective tissue disease
 Risk factors for rupture: diastolic HTN, initially large size
at diagnosis, COPD, symptomatic, recent rapid
expansion
 Diagnosis
 Exam
 Periumbilical palpable pulsatile mass
 Ultrasound
 Study of choice for initial diagnosis
 Used to follow progression of aneurysm over
time
 Abdominal or back radiographs
 Calcifications of aneurysm wall may be seen in
~75% of patients
 Diagnosis
 CT scan
 Character, wall thickness, location with respect to
renal arteries, presence of leak or rupture
 With Contrast for visualization of surrounding
vasculature; essential for planning repair
 MRI
 Greater detail than CT or US regarding lumen, surface
anatomy, neck, relationship to renal arteries
 Angiogram
 Defines vascular anatomy, assess lumen patency and
iliac/renal involvement
 Especially important in cases of mesenteric ischemia,
HTN, renal dysfunction, horseshoe kidney,
claudication
 AAA Screening
 U.S. Preventive Services Task Force
recommends one-time screening by
ultrasonography in men age 65 to 75 years who
have ever smoked
 No recommendation (for or against) screening in
men age 65 to 75 who have never smoked, and
an explicit recommendation against routine
screening in women, based on the relatively low
yield
 Repeated screening does not appear to be
needed
Radiograph
Ultrasound
Ultrasound
Ultrasound
CT scan
CT with contrast
CT with contrast
CT Three Dimensional
Reconstruction
Angiogram
 Triad of Rupture

 Abdominal pain
 Pulsatile abdominal mass
 Hypotension
X-ray
CT scan
Any Questions?