Abdominal aortic aneurysm

Background

• Infrarenal diameter >3cm or >50% increase in size of diameter
• Rupture Risk
  • <4cm: low risk for rupture
  • 4-5cm: 5 year risk 3-12%
  • >5cm: 25-41%
  • Rupture poss at any size, most commonly >5cm

Risk Factors

1. Age
   1. Prevalence is negligible in age < 50 yrs
2. Smoking
   1. Risk factor most strongly assoc with AAA
   2. Also promotes the rate of aneurysm growth
3. Family history
4. HTN

Diagnosis

• Sudden, severe abdominal/back pain
• Syncope (10%)
• Pain + AAA = rupture until proven otherwise
• Acute abdomen + hypotension = possible rupture

Workup

• US (cannot see rupture)
• CT Noncon (if stable)

Treatment

• Rupture
  • -->EMERGENT SURG/Endovasc
  • Do not waste time for stablization --> OR
  • T&C x 6-10U PRBCs, 4U FFP and 4U platelets
  • Maintain BP high enough to keep asymptomatic end organ (like penetrating tauma)
  • Do not lower BP if R/O rupture (chronic ok)
• Asymptomatic
  • -->Incidental finding: f/u Vascular

Source

Tintinalli, UpToDate