Abdominal Aortic Aneurysm (AAA)

AAA occurs in 5 to 7% of adults 60 years and older . Most cases are assymptomatic and often is found by the astute physician as a pulsatile abdominal mass ? left of midline between xiphoid process and umbilicus.The mean normal size of the infrarenal aorta is 21.4mm in men and 18.7 mm in women When an aneurysm is greater than 50 mm serious consideration for repair should be entertained as there is a 20% chance of acute rupture that as you may imagine , can be catastrophic and terminal .

Though 75% of cases are assymtomatic they may be detected during routine exam or during radiological or surgical procedures. When symptomatic the most common presentation is one of pain ie abdominal , flank or back pain . Pressure on adjacent viscera may result in bowel compression and symptoms of early satiety , nausea or vomiting and rarely urethral obstructive symptoms . Embolization of aortic thrombi may also occur. The abrupt onset of severe , constant pain in the abdomen , flank , or back unrelieved by positional changes , is characteristic of expansion or rupture of the aneurysm .Etiology is multifactorial but the most commom cause traditionally is considered to be atherosclerosis. However mycotic infections , , cystic medial necrosis, Ehlers-Danlos syndrome are other etioogic considerations.

Diagnosis is facilitated by physical exam , B mode ultrasonagraphy ,

ct scan ,ct angiograms and angiography.

saggital 53 mm aortic aneurysm on ultrasound evaluation of 65 year old male complaining of some abdominal pain with BP 210/110. Peculiarly pain resolved on BP control and patient steered toward surgical repair.These patient often are of significant cardiac risk and so merit adequate cardiac pre-op evaluation.

Repair should seriously be considered when aneurysm greater than 5 cm

This condition has been cited as the 13th leading cause of death in the USA .