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:

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

Diagnosis

• May be asymptomatic or abdominal/back pain
• Pain + AAA = rupture until proven otherwise
• Acute abdomen + BP = possible rupture

Workup

• US (cannot see rupture)

CT Noncon (if stable)

Treatment

Rupture-EMERGENT SURG/Endovasc

(do not waste time for stablization)

-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

Donaldson, Bessen, H-N, UpToDate