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