Abdominal Aortic Aneurysm

Abdominal aortic aneurysm is a pathologic condition with progressive abdominal aortic dilatation of 3.0 cm or more that predisposes the abdominal aorta to rupture. Most abdominal aortic aneurysms are asymptomatic until they rupture, although some are detected when an imaging study is performed for other reasons. The risk factors for abdominal aortic aneurysm include hypertension, coronary artery disease, tobacco use, male sex, a family history of abdominal aortic aneurysm, age older than 65 years, and peripheral artery disease. Abdominal ultrasonography is the preferred modality to screen for abdominal aortic aneurysm because of its cost-effectiveness and lack of exposure to ionizing radiation. Abdominal aortic aneurysm can be managed medically or surgically, depending on the patient’s symptoms and the size and growth rate of the aneurysm. Medical management is appropriate for asymptomatic patients and smaller aneurysms and includes tobacco cessation and therapy for cardiovascular risk reduction. Surgical management, which includes open and endovascular aneurysm repair, is indicated when the aneurysm diameter is 5.5 cm or larger in men and 5.0 cm or larger in women. Surveillance of abdominal aortic aneurysm depends on the size and growth rate of the aneurysm. The most serious complication of abdominal aortic aneurysm is rupture, which requires emergent surgical intervention. The U.S. Preventive Services Task Force recommends that men with a history of smoking who are 65 to 75 years of age should undergo one-time abdominal aortic aneurysm screening with ultrasonography.